Dr. Robert Lustig: How Sugar & Processed Foods Impact Your Health

44:33So yeah, I don't I don't know it off the top of my head 41 41 41 2 to the 41 Doublings gives you an organ is a 10 trillion cells We're 10 trillion cells or 10 trillion cells. We know that yeah Okay 2 to the 41 okay, okay now of those 41 doublings Some of them had to occur in utero Some of them had to occur postnatally So I need two numbers that add up to 41. How many in utero? How many postnatally? Well way more You start off with a lot more than you end up with But then you have cells that turn over throughout the life spans. This is a tough one Okay, because skin cells turn over With neurons it's it's pretty straightforward Because you're gonna Somewhere what you get in 10 right well you're and you're born with somewhere between three and 10 acts of what you end up with Depending on the brain structure.

45:31Yeah, so but for whole body wide. I don't know how you'd come up with that number 36 and 5 Okay, 36 doublings prenatally 5 doublings postnatally and I can prove that to you too Typical baby weighs seven pounds First doubling 14 pounds second doubling 20 of eight pounds sex doubling 56 pounds next doubling 112 pounds next doubling 224 pounds hopefully it's tough. It'll be syndicates. Hopefully it's toughs there Not not not all people do an 12 pounds or obese But some people who are Certain heights or below or 200 12 or obese. Okay point is the cell has to know when to grow and when to burn It turns out that the signal for that is oxygen Because oxygen is necessary for mitochondria to be able to burn in the absence of oxygen The cell only knows how to grow This is actually why out of warburg won the Nobel Prize in 1931 for the warberg effect He asked the question how come cancer cells Don't need oxygen to grow and the answer is because no cell needs oxygen to grow in fact oxygen is the thing that prevents growth Famous article from the New England Journal of Medicine 1951 Mount Everest in utero Because every fetus is oxygen deprived So Normal partial pressure of oxygen 100 millimeters of mercury out here right and if you if I check your blood and be about 100 right I hope so how about a tumor cell Um guessing tumor cells probably It's a double about 44 Wait, you just told our pressure of oxygen in a tumor cell it's about 44 But you just told me that well tumor cells which grow like wild right They grow like wild because they don't have oxygen But they but there's some of the so here's what's peculiar about it um Tumor cells are some of the most vascularized cells or tumors are have been asking I mean one way to one way to get a new Kill one is to to de vascularize the tumor cell right yes, and you know angiogenesis inhibition etc As you know it's a big deal you know jutefocum and all that from Harvard you know So the excess blood to a tumor is the attempt to bring in oxygen that it's not getting that's right as opposed to delivering lots of oxygen and that's why it's growing That's right okay But a fetus what's the partial pressure in the placenta 6 to 31 So it's actually like a mile above Mount Everest That's how much oxygen the fetus gets and it's that for that reason that you've got 36 dumplings and then as soon as you're out, you know You cut the cord and you start breathing and now your partial pressures at a hundred that's when Growth slows down Has there been any effort to treat tumors by oxygenating tumors?

48:36Yes, and what does that look like it's Hyperbaric oxygen therapy. It's a thing. Oh, yeah. Yeah. Yeah. We will probably do an episode on hyperbaric chambers The the reason we haven't yet is it's pretty niche into it But there are people who own these things who sit in these things Okay, so we got here by way of by way of carped by the bagel right Um, so I just want to orient us That you just that 250 calories of the the bagel we talked about glucose Excuses that insulin rise that's driving the out of positing and also driving the growth Okay in the absence of oxygen because if you have oxygen then you don't Need that much insulin Okay, so Because you're gonna burn instead of store got it In terms of the the the raw metabolism of carbohydrate though that glucose If I eat 250 calories a glucose how much of that did I quote unquote actually eat how much is he is used How much is he used yeah, let's assume that I'm at my desk working or I'm walking around a little bit I'm not I'm not exercising hard in the in the subsequent hour.

49:51So used for what is the question The calorie is is the calorie a calorie clearly the answers no Based on the processing of different types of calories we established it for fat the almonds we established it for protein Right the porterhouse with butter and now we're we're trying to establish that for the 250 calories of a bagel Which is glucose right so the glucose has to be fussed for related so you're gonna lose And an ATP in the process so you're gonna go ATP goes to ADP And then that ADP will go to AMP Adenosine monophosphate which will then go to IMP inocital monophosphate which will then go to uric acid Okay, and that uric acid will be then released from the cell circulate in the bloodstream and hopefully go out in the kidney In the process that uric acid can inhibit mitochondrial function And it can also inhibit endothelial nitric oxide synthase which is the enzyme In your vascular that is your endogenous blood pressure lower right by expanding blood vessels and capillaries exactly This is the mechanistic Foundation of the drugs that were originally used for Improving prostate function, but are used to treat erectile dysfunction, which are the the pd5 inhibitors which allow nitric oxide to be Around longer and more of it right people use it for other purposes too I'm now known.

51:15I'll forget if I queue it up with that example We you know in the neonatal intensive care unit it closes patent ductus arteriosus which is a big deal in In the neonatal world. Well, okay. I want to ask you about that, but but um, so I heard two things one is that glucose and the insulin that goes with it increases uric acid uric acid While it has certain important functions in health too much of it you said can inhibit nitric oxide. Yeah, can You know, so that means that the blood vessels and capillaries are going to stay more constricted So blood pressure is going to be higher than it would be normally that's right and then uric acid is also inhibiting mitochondrial function That's right.

51:55Okay But eating half a bagel isn't necessarily a terrible thing if it's within your caloric requirements It and it it all depends on how much You clear and how high your insulin goes now. Let's compare that 250 calories of glucose To 250 calories of fructose right Let's let's come up with a food example 250 calories of fructose would be trivial to Consume in the form of high fructose corn syrup right well So remember the high fructose corn syrup is half glucose half fructose. Okay, so let's go 125 125. So let's not use that well, so let's assume um, so we can talk about a soda For uh to get that that uh 250 calories easily Um, especially if it's not a can or a European -sized bottle or two ounce eight ounce can of soda.

52:48Okay, so eight ounce can of soda Um, and maybe let's include a food item. Let's talk like a store -bought packaged cookie couple Oreos two Oreos Okay, probably get you to that 250 or maybe four or maybe three Oreos. Yeah, okay Oreo lovers everywhere celebrating three 250 calories of fructose What's the effect on your Acacid? What's the effect on caloric burn? What's the effect on anything for that matter that uh, we should be aware of All right, so first of all the Oreo has plenty of fructose in it. So keep that in mind. Okay. The um if let's say you consumed 250 calories in a bagel because that's pretty much polymerized glucose Versus say the soda so the bagel versus the soda that's what you're equivalent calories, right equivalent calories or the the bagel versus let's say two Oreos and a little bit of um and yeah two Oreos.

53:40Okay, so number one There's only half the glucose in the soda because the other half is the fructose so 125 -125 So your glucose rise won't be as high your glucose excursion will be lower This is actually one of the reasons why There's this thing called glycemic index And glycemic index is an art. It's garbage. It is complete and utter BS the glycemic index absolutely yes nothing nothing is more uh, egregious in terms of uh, argument than then then the glycemic index and this is one of the things the dieticians as Promote and a spouse and one of the things that's got to go Okay, well, this is an idea that must die.

54:28Okay, we'll get back to why the glycemic index has got to die but so so that 250 calories and actually can we Can we make these equal just for sake of of simplicity? Can we say 250 calories of glucose from the bagel versus 250 calories of fructose How do we get 250 calories of pure fructose? We don't you can't okay? You got to bring the glucose Lab fructose you have to make it then let's stay with your nose, which is a half glucose half fructose Right, that's I mean there is no fructose alone in nature even cracker some of the ones that are salty are also sweet They have fructose in them. Yeah, I'm sure high fructose corn syrup.

55:04Yeah, that's why it's impossible to eat just one Indeed and um so What's happening biochemically with as a consequence of the fructose component specifically? So the fructose will first of all go into the intestine The intestine will metabolize some of that fructose Through what is known as intestinal denova lipogenesis about 10 % of that fructose will be turned into fat Right in the intestine and that's because fructose it just wants to be fat Yeah, fructose wants to be fat fructose is the lipogenics substrate here We're not talking about body fat. We're talking about fat molecules that can potentially be used as energy That's right triglyceride molecules Okay, so that so 10 % of that fructose will be turned into triglyceride right in the intestine and be released into the bloodstream And it is the reason for a post -prandial triglyceride response post -prandial is uh and I'm including myself in this group is nerd speak for after eating ludge Typically it's ludge and the So that's actually one of the drivers of cardiovascular pathology That intestinal denova lipogenesis turning that fructose into triglyceride right in the intestine Now there's a limit to how fast and how much the intestine can do that The rest of the fructose will be uh absorbed into the portal vein But not before Some of that fructose will make it further down and it will nitrate Tight junction proteins now okay portal vein of the kidney so portal vein goes to the liver Portal vein goes from the visceral from the intestine to the liver.

56:43No kidney doesn't begin okay In intestine to liver okay, okay, but fructose nitrates tight junction proteins now let me explain that to your audience Your intestine is a sewer Definition of a sewer a pipe with shitnet Okay, that's its sewer our intestines are sewers There's junk in the center and The job of the intestine is to move the junk through to the anus absorbing the good stuff Why you can't the intestine is made up of cells intestinal epithelial cells that are bound together and they're bound with proteins that basically form a barrier Those barriers are called tight junction proteins.

57:34It's like cloud ins and things like that um Zanulin is the main one okay, there are others, but Zanulin is the one that goes is defective in celiac disease What defines a tight junction is it that is that completely impermeable or semi permeable Completely impermeable okay unless its function is inhibited Turns out if you alter the phosphorylation status or the nitrate status of that tight junction it will become transiently permeable Okay, and so fructose nitrates tight junction proteins causing them to be transiently permeable allowing some of the junk in your intestine to get through Into your bloodstream.

58:20So this is leaky gut. This is leaky gut. This is what causes leaky gut fructose is a driver of leaky gut Got it That causes inflammation at the level of the liver which ultimately leads to systemic inflammation one of the reasons why High -sensitivity CRP sensitivity CRP is high in patients who eat ultra -process food CRP is c -reactive protein which is a marker of a essentially inflammatory immune response exactly You don't want it too high and 93 % of Americans today are inflamed Does that mean the 93 % of Americans have leaky guts? Yeah, it does because that's where it comes from so in addition to limiting fructose intake What are things that um Support the tight junctions of of the intestinal pathway?

59:10So there are three barriers in your intestine to keep the junk Where it belongs in the center So that it can get pooped out the you're behind all right three separate barriers one is a physical barrier Called the mucin layer So it's a layer of mucous that actually sits on top of the intestinal epithelial cells now That mucin is a polysaccharide and The bacteria can use that mucin layer for its own purposes. It will eat your mucin layer if you don't feed your bacteria You must feed your bacteria or back your bacteria will feed on you Okay, so you are in concert with your microbiome if you deprive your microbiome of the food that it needs It will use you as its food and that's one of the reasons why fiber is so important So fiber to build up this mucin layer is one way to reinforce the the fence that that is the tight junctions etc Between your intestine and the bloodstream exactly this raises an interesting point about fasting Many people including myself do a sort of pseudo intermittent fasting I might eat my first meal somewhere between 11 and noon.

1:00:23I'm not strict about this The 11 versus noon thing and probably eat my last bite of food somewhere around 8 pm and occasionally it's outside that window I've done this for a long time. It just feels best to me Right, but other people use a shorter eating window one thing that I learned from a colleague at Yale The studies that got microbiome that was surprising to me is that when you do when you eat in that way There's a long stretch of time sometimes longer for people that have a shorter eating window longer fasting window that is Yeah Where you're actually eating up your own intestinal lining that so this idea that fasting is so great for us on the one hand Might be true on the other hand you're you're actually consuming components of your you're not feeding your gut microbiome And you deplete it, but then here's where I was so positively surprised when you do eat provided that you eat enough fiber and in particular high quality fermented foods lotion fermented foods It seems that the the lining of the gut and the gut microbiome is replenished to a Level that is greater than if you had eaten for longer periods of the 24 hour cycle.

1:01:26Yeah, I have that right We do you do have it right and I don't know why that is true But it does seem to be the case and fermented foods they it part because they've got already short -chain fatty acids in them Seems that the preferred food of the microbiome well, it's what the microbiome actually turns fiber into So it's probably helping your intestinal epithelial cells in the same way What the microbiome turning fiber into short -chain fatty acids helps? So it's what we call a postbiotic so you have prebiotic which is the food for the bacteria You have the probiotic which is the bacteria itself and then you have the postbiotic Which is what the bacteria make in order to heal you Okay, and so short -chain fatty acids are postbiotics and there are a lot of people selling Short -chain fatty acids, you know Drinks and supplements and what have you whether they work or not as another story if I consume fructose in the form of let's say a highly processed food as minimal antioxidants It's got plenty of calories typically And it's disrupting the tight junctions making my gut leaky, right, but I'm also eating fiber Yeah, you know, I'm having a you know a meal that includes a salad I'm having having some probiotics and then I want to like a couple of recess peanut butter cups like in the dark chocolate ones in particular I don't do this anymore, but I used to eat like that more often as time has gone on I've become I don't like to call it stricter, but more I I tend to like healthier foods over time And I think you can get away with different things at different stages of life Although you work with young people so we'll we'll get to very young people so we'll get to this but How how much damage am I doing by ingesting any fructose in the form of a highly processed food?

1:03:12So I'll make it very simple Andrew I am for dessert For dessert I am not for dessert for breakfast lunch snacks and dinner Okay, so if you want to have a couple of Reese's peanut butter cups as your dessert In the same way as you might have a cognac for dessert That's fine. I have no problem with that The question is are you going to eat Reese's peanut butter cups for breakfast? No, I don't eat breakfast, but no, but I get your point the National School Breakfast Program Which 29 % of school children today consume is a bowl of fruit loops in the glass of orange juice That is 41 grams of sugar American Heart Association says that the upper limit for children should be 12 grams of added sugar per day That's 41 grams of added sugar and it's just breakfast and that's fructose rich Totally right completely so the question is Which dessert are we talking about?

1:04:23Right and can we can we adjust that morning meal to a different reality because I agree that there are plenty of kids eating that or a muffin that might be the equivalent But what about the parent who says okay, let's come up with a healthier option that the kids still likes like I'm thinking back to my childhood like a honey nut Cheerios or something so not fruit loops, which is kind of the extreme Um, take a look at the side of the package No difference now let's say they go with some like Waffles that are made so with a with a pre -made mix some milk some butter You know, so mom or dad is making waffles great sounds healthier But then if you do the breakdown or we're still ending up at very high are we basically eating dessert for breakfast?

1:05:11Are we eating egg o' waffles or we making making waffles Denouvo, you know from scratch in your own kitchen. Let's say big difference Okay, because the egg o' waffles, you know replete With sugar on purpose because the food industry knows when they add it you buy more because it's addictive Okay, and we actually have the demographic the mechanistic the imaging and also the economic data to demonstrate that sugars addictive and the food Industry knows it So have you ever heard of a phenomenon called price elasticity? Okay, price elasticity is an economic term that is used To ask the question if the price of a given good goes up by 1 % That should result in reduction in purchase or consumption Because price influences consumption How much does it influence it?

1:06:14So if it's if something's price elastic When the price goes up consumption goes down equivalently A food that is price elastic the most price elastic food is eggs So when the price of eggs goes up 1 % consumption of eggs goes down 0 .68 % Meaning that eggs have a price elasticity of 0 .32 Got it got it now. What's the most price any elastic food? The top three most price any elastic foods are fast food cereal 0 .81 I like a good quiz Has food 0 .81 Soft drinks at 0 .79 and juice at 0 .77 Meaning people will pay not whatever but they'll they're willing to pay more more more readily willing to pay more Because of the sugar because it's addictive because it's hedonic So Many many years ago Andrew you probably remember something called canesian economics And canesian economics was based on this concept of the rational actor And the rational act can determine value Which is utility over cost And if you're a rational actor you should be able to say yeah, I'll buy that But I won't buy that right?

1:07:42Okay 1979 Daniel canoman and Amist first ski Nobel Prize winner Daniel canoman Describe the irrational actor Now the irrational actor cannot determine value And the reason is because he is a risk of verse So the cost is always too great So the utility may be the same But the cost goes up because that's why they have you know a verse of tendencies the irrational actor Jeffrey Sachs has described the hedonic actor Who also cannot determine value Because it doesn't matter what a cost they need their fix And this is what's going on and the food industry knows it And that's why every food in the store has been spiked We talked about dessert for breakfast in the form of cereals some of which are disguised Or couched as healthier you know, I think of like honey nut choreo So it seems healthier than fruit loops it looks healthier like the cut just by way of color It looks kind of weedy you know color So but let it in terms of lunch I mean one of the things that I love about Europe is that the breads are amazing Yeah, and it's a terrific there and I like and I like them because they're not as sweet Exactly and so a sandwich from not every deli but from a typical sandwich shopper that one makes with store bought bread slice bread in the US Has a lot of fructose I look at that looked this up prior to discussion today So in some ways dessert is being woven into foods that are That parents and or kids everyone thinks our savory are we're actually using sweets exactly right But we can't but we don't taste them as sweet at a conscious level necessarily right But our taste buds do right that's exactly right.

1:09:35So the question is why do they do that So question for your audience You buy a loaf of bread at the local bakery How soon before it stales? Two days to the best yeah if it's really great bread that's right the better the bread the quicker it stales You buy a loaf of bread at the Uh neighborhood grocery store How soon before it stales? You've got probably a week and then there's the moldy pieces at the end and they can truck That you know if you're in college and you were me trying to save that off Um, but can last up to three weeks depending right you could throw it in the freezer You probably do that with the bakery bread, but it's never the same never the same So the question is why is that and the answer is sugar The answer is sugar So the grocery store bread had sugar added to it on purpose Because when you bake it The sugar does not evaporate it stays in the bread and the sugar is high -grow scopic meaning it holds on to water This is a phenomenon that the food industry uses called water activity Okay, and so it will hold on to water and so it will stay spongy and it will not stale as quickly as the bakery store bread Which did not have that sugar added to it So even something as benign as bread has been turned into Something that ultimately leads to chronic metabolic disease We've pivoted somewhat from carbohydrate divided into glucose and fructose to a discussion of sugar Could you tell us the link between sugar and fructose?

1:11:14So table sugar what percentage of table sugar is fructose? What percentage of brown sugar is fructose? What percentage of the sugar that's added to food is high fructose corn syrup on average? You know just because here what we're talking about is What you're describing as an intentional lacing of food with something that's addictive But that's also processed very differently at the level of the kidney at the level of the liver um And It's bad. It's a bad situation So so when we talk about sugar I think we need to be as careful in describing what we really mean as when we talk about a calorie I completely agree So let for your audience let's be very very clear on definitions Okay Let's not use the word sugar because it has multiple definitions Let's use sucrose sucrose is What you put in your coffee it's the crystals All right, it's cane sugar, beet sugar You know the you know the stuff that you teespoons of right this was all that was available for many many years That is one molecule glucose one molecule of fructose bound together For the chemist out there an o glycositic linkage Okay, the enzyme in your intestine called sucrose Cleaves this o glycositic linkage in about a nanosecond you absorb the two molecules separately The glucose goes to the entire body Generates an insulin response the fructose goes straight to your liver generates fat That's sucrose high fructose corn syrup is essentially one molecule of glucose one molecule of fructose Not bound together no o glycositic linkage So they're free The enzyme sucrose doesn't care because the blondes already broken Ultimately, they do the same thing and that's why high fructose corn syrup and sucrose are indistinguishable metabolically What they are is they're very different economically and the reason is because high fructose corn serves half the price of sucrose Because sucrose we get from importing And high fructose corn syrup we make it home sucrose is in bags high fructose corn syrup is in barrels sucrose you can sell at the store high fructose corn syrup you sell to the You know ultra -process food manufacturer you can't buy high fructose corn syrup at the You know at the grocery store So they're very different in terms of what they're used for High fructose corn syrup is particularly egregious because it's so missible because it's already a liquid So you've probably remember chips and hoi cookies in the old days Okay, they would often would seem like the sugar in the Cookie had crystallized because the sugar content was so high It's been a while since I've had one they weren't particularly good.

1:14:31Yeah Like now, but you eat two of them And then you think they're good and then you want to eat four. Yeah, that's what's so odd the first bite is kind of like the and then It's bombs away. There you go Well now it's a chewy chips of white cookies. Oh, I remember the reason chips of it. Remember chewy chips Well, that that's high fructose corn syrup because Because the two molecules are free They don't crystallize So you can actually up the dose Several times throughout today's discussion you've been talking about the quote unquote food industry Okay, so I'm not a conspiracy theorist but I understand You know that most businesses exist to make money.

1:15:17Yeah many businesses start off with good intentions and drift in order to stay To stay competitive And many many businesses As we know Not all of which are entirely bad such as the pharmaceutical industry. All right. You were they're bad They're instances of like the opioid crisis But then there are drugs from the pharmaceutical industry that help save lives. I mean, that's my my stance Um the food industry. I think they're good actors and they're bad actors But we're talking about the food industry here. Okay. What we talk about the exercise industry We talk about the podcast industry. I mean you got good actors and bad actors But what you've alluded to several times here and you're more informed than I am is a a Concerted effort to lace food with a form of sugar that makes people crave more of that food and that is causing Metabolic illness disrupting mitochondria And on and on exactly and you're the physician not me um, you've worked with patients who struggle with obesity and for various reasons um not me and um So We could probably spend hours if not days talking about all the terrible things that the quote unquote food industry has done but What do you think is that the pure motivation right?

1:16:38I don't think that they want people to be sick But they want to sell product and this sells more product. So then it raises two questions If Why is it that More people don't know about know this information although many more will know aftertaste conversation And certainly in government it's a mix Regardless of what side of the aisle you're on or if you're right in between They're they're clearly people that care about the health of themselves and others so I can understand how things might have gotten to this point But What do you think are the barriers to getting people to appreciate just what a problem this is and And getting people to change their choices in terms of what they're eating are they truly addicted to the point where they are sick They can't make good decisions like a like a drug addict who's highly addicted to heroin is a sick person They have an illness and they need treatment But until they get that treatment they can't make good decisions Let's take an analogy alcohol 40 % of americans are T totalers never touch the stuff 40 % don't drink great I'm not a big fan of alcohol.

1:17:47I've never seen it make anyone better at anything that really mattered No because it's drinking It's also completely vestigial. There's no Biochemical reaction in the body that requires alcohol Okay, for the same reason by the way fructose 40 % are social drinkers. Yeah, you can pick up a beer put it down. I'm in that category 10 % are binge drinkers and 10 % are chronic alcoholics Okay, now do you deprive the 40 % of social drinkers because of the 20 % of Binge drinkers and chronic alcoholics? No, I believe people should be in choice But I believe people should know what they are doing So that they can be in choice.

1:18:31Well, right? Like do as you I always say And I said this about the alcohol episode which turned out to be one of our most prolific episodes Where I said that you know more than two drinks Zero is better than any and more than two drinks per week You need to do other things to offset that and it's problematic That's what those are what the data say, but I but I would say do as you want but know what you're doing Well, so I would say that that's exactly what the food industry wants you to think That's it that is the food industries mantra is you have your own choice personal responsibility So the question is does personal responsibility work?

1:19:09The answer is no, it doesn't every uh Public health debacle in the history of mankind Started out as a personal health issue before before it became a public health crisis and you can pick your You know personal responsibility issue whether it be exposures whether it be addictions whether it be infections Bottom line is ultimately it required a societal response Okay We can talk about syphilis we can talk about tuberculosis ultimately needed a public health response we can talk about um uh teen pregnancy we can talk about tobacco tobacco Ultimately needs a public health response because the sheer enormity of it and the uh the egregiousness of it Requires that public health response well turns out This is no different In order to exercise personal responsibility For criteria have to be met Those four criteria are the following Number one knowledge You have to have the knowledge Because if you don't have the knowledge and how can you exercise personal responsibility?

1:20:20Well in fact The public's being kept from the knowledge. We're doing this now in part to in you know to entrain that knowledge to to get people to understand What the problem is yeah, I mean I consider myself pretty informed about nutrition and health but Already today I've learned two dozen facts about processing of fructose and colore calories generally that I had no knowledge of prior Well, that's good okay because it's not about the math. It's about the science Okay, they wanted to be about calories so we have this thing called food science We have this thing called nutrition and we have this thing called metabolic health They are not the same Food science is what happens to food between the ground and the mouth nutrition is what happens to food between the mouth and the cell metabolic health is what happens to food inside the cell But all of the chronic diseases that we are suffering from type 2 diabetes hypertension Dislipidemia cardiovascular disease cancer dementia fatty liver disease Polycystic ovarian disease those eight diseases which make up 75 % of healthcare expenditures in this country today Are all inside the cell because they are all mitochondrial dysfunction and there is no Medicine that gets to the mitochondria although you and others at Stanford Harvard etc Are starting this with the metabolic psychiatry being one instance right indeed and you see us off as well for giving Just mention you see us up on your your home institution wonderful institution right off the road from Stanford So you know things are changing people are starting to think about mitochondrial health Okay, so you list up the first the first thing you said there four things that stand as bear first one was a knowledge Okay second access Because if you don't have access then how can you exercise personal responsibilities access to healthier alternatives exactly Which means cost effective.

1:22:16I mean I love Berries from the farmers market more than I love berries from the store. I love The farmers markets generally but it takes time energy to go there and The cost is actually lower at the level of what you hand the vendor typically right but Volume is tough to achieve right they actually have me at a quota I'm not allowed to buy as many berries as I want because obviously there are other people who want berries So there's that right people have to feed their family that you know and well We're used to eating a lot of volume, but you're able to at least go there sometimes, okay? We're talking about people who live in quote food deserts We're also talking about people who live in food swamps.

1:22:56Okay, and when we're talking about food swamps We're not talking about and plethora of healthy foods. We're talking about all the junk That's what they they live in the swamp of junk So if you live in the swamp of junk, how are you supposed to exercise personal responsibility? number three uh Or affordability So you have to be able to afford your choice and society has to be able to afford your choice And right now we can't afford that choice because Healthcare costs right now are at $4 .1 trillion a year, but like so many things in Behavioral economics and health it's so hard for people to see that the immediate choice Is leading to a higher cost down the road There's just too many nodes of separation for people who realize hey when I'm reaching for this cereal as opposed to Making waffles for my kids from scratch or you know, they're thinking time efficiency cost efficiency volume The kids not throwing tantrums because they're not no longer getting the cereal and it's very difficult to see This is the reason why healthcare costs are going up.

1:24:04There are just too many nodes of separation Couldn't agree more, but the ultimately it's because the government separates and silos Food industry profits from healthcare costs if you actually combine those Because they ultimately are the same you would see the problem So globally the food industry grosses $9 trillion a year Healthcare costs globally cost $11 trillion a year Dietary related healthcare costs Environmental costs Cost $7 trillion a year and productivity costs cost one trillion dollars a year So when you do the math 9 minus 11 minus 7 minus 1 means that there is a 10 trillion dollar a year deficit Because of us cleaning up the mess that the food industry makes and while numbers like that that's not affordable Right, I agree and while numbers like that land really hard I find that for myself and for many people statistics like that are hard to keep in mind in a way There's something about the human brain that hears that and goes whoa We're like that war costs that much and this food issue costs that much And then we go to the store and we're hungry right and the kids are are are hungry and you're and so Those nodes of separation.

1:25:28It's it's almost like a neural slash memory slash prefrontal cortex issue to me and of course I look at everything through the lens of neurobiology too, you know, not everything but most everything and so how How could I not how could we not but Then like the issue is well, there's still food on the shelves and you know, and so it's very how what do we do to connect It's it bring closer together these no more questions the government do so the question is is their food on the shelves Let me finish the fourth one and then I want to come back to that point. Let me just you know finish a concept So affordability and number four externalities your choice can't hurt anybody else But what if your choice does hurt somebody else?

1:26:11So like for tobacco second -hand smoke right for alcohol drunk driving But what's the argument for teen pregnancy that someone else was gonna have to raise the kids exactly But what about for food? Okay, well how about the fact that your employer stand for a university has to pay $2 ,750 Uh, per year in obesity related health care expenses that they have passed on to you Even though you're not obese That is affecting you so That guy is obesity right there that is affecting you, but there nowadays it's especially Tricky even to have the conversation. I'm willing to have it now Yeah, which is that you know that there's this whole concept of fat shaming right so if somebody's obese whose fault is it and if we even talk about it Is uh are we subject to um attack legitimate attack you know, so like so calling something oh Oh someone obese at a clinical level like having here you're an expert in Don't talk about you don't talk about obesity.

1:27:19Let's talk about diabetes Okay, so talk about different consequence of obesity. Yeah, let's talk about the metabolic health issue itself Okay, the fact is that diabetes is now 11 .4 % of America. What was it 20 years ago? It was 20 years ago. It was about eight percent. I was wondering this earlier 20 years ago There was a lot more margin in refrigerators But people were thinner and there was less diabetes. Yeah, everything you talk about margin and trans fats is that it's bad bad bad now Butter is back as time magazine and you said right so Clearly can't be the transition away from trans fats.

1:27:57That's increased obesity. Well no No, so it's gonna be the increase in sugar and increase in sugar and these hidden sugars in exactly. That's right I the the the key though is Pakistan and India because and China they are not fat But they have 14 % diabetes rates and they're thin And the reason is because of ultra -process food. Are there any countries in the world that Don't allow high fructose corn syrup or at least not at the level that that we do oh their free foods, okay? There are boatloads of countries that don't import high fructose corn syrup or don't make it so Scandinavian countries Scandinavian countries most of Europe The other than the Asia Pacific Rim so Japan has it in fact it was invented in Japan 1966 saga medical school Takasaki et al Korea has it But Australia does not have it Thailand does not have it but they have just as much of an Obesity and diabetes problem as we do because they have sucrose Because high fructose corn syrup and sucrose are no different Metabolically, so it doesn't really matter is that one -to -one it's the one -to -one thing exactly a glucose and fructose so here's the question Okay, I want so I want to go back to that You said all this food is still on the shelves Is it food?

1:29:27What is the definition of food? Could I give the definition? I think most people would give that's not sort of the one I would I would give but Something that has contains caloric energy or like I could eat this microphone Um, but it's not gonna provide much useful energy The definition of food straight from the dictionary and believe me I looked it up and memorized it. I believe you Substrate that contributes to either growth or burning of an organism Interesting that is the definition of food. I'm free scientific 100 % correct growth or burning so any substrate that passes your lips that contributes to either growth or burning That's food.

1:30:12Okay, let's do it Let's do burning first. I just showed you that sugar which is the marker of ultra -process food and 73 % of the items in the grocery store are Spiked with sugar inhibits burning Inhibits those three enzymes involved in mitochondrial function Now let's do growth my colleague doctor a fraught moncinigo or non who is the chairman of nutrition at Hebrew University Jerusalem Actually looked at this question and showed that ultra -process food actually inhibits growth It inhibits cortical bone growth it inhibits Tribicular bone growth it inhibits Cancel this bone growth inhibits linear bone growth It hijacks growth for cancer because It inhibits mitochondria and so You have to then grow instead of burn and this was work that was done in in vivo or in vitro in vivo So these are people that are eating high amounts of highly processed food exactly.

1:31:12How did you find those in the in the middle east? They they found in Israel they found so bottom line is if a substrate does not contribute to growth and does not contribute to burning Is it a food? I see answer is no Well, that's 73 % of what's on the grocery store? So I would argue you said the food's there. No, it's not That's not food In fact, it's consumable poison so This leads to an important question of what's left right you remove all that what's left? Just anecdotally and what I sometimes call anecdata You know, I've had several friends in their 40s and early 50s say they want to lose weight and get in shape and the thing that's worked every every single time for them to lose significant amounts of weight quickly and keep it off and many of them were already exercising but then also increase their exercise Was I just since I'm not a dietitian nutritionist or anything.

1:32:15I just say eat meat fish eggs vegetables fruits You're not going to eat starches. You're not going to drink alcohol. You're not going to drink soda You can still have coffee tea You can still have artificial sweeteners. I will get to artificial sweeteners a little bit. We have to go but um and The reason I say no starches even though I personally eat rice oatmeal pasta things of that sort some in in moderation Depending on on what sort of exercise and I'm doing and how much is because of the fact that nowadays many of those things contain fructose and inevitably Every one of those people is blown away by the fact that it quote -unquote works and assumes that it's all because of reduced calorie and take overall and They lose like Anywhere from 30 to 55 pounds and keep it off and they're like hey, this is great I can actually still eat rib -i -stakes and salads and But they're not eating croutons there and so in some sense it looks extreme it sounds ketogenic But it's nothing like that you're just saying basically stay away from you're limiting process foods You're eliminating liquid calories in in general And on and on and so there's nothing sophisticated about it and my question to you is how much of that Weight loss effect do you think is a calories versus calories out affect because they're eating a lot of food and in some cases and how much of it do you think is the elimination or near elimination of this fructose or this glucose fructose combination?

1:33:49It's nothing to do with the calories It has everything to do with the insulin If you get the insulin down You're not shunting energy to fat You can lose weight your fat will give up The the the the the triglyceride stored in it as soon as your insulin goes down insulin is pushing on your fat cell all the time and as long as your insulin's up Your fat cell can't release it the minute your insulin goes down You can now engage in what we call lipolusus Hormone sensitive lipase is an enzyme in the fat cell that is inhibited by insulin as soon as the insulin's gone Hormone sensitive lipase can turn that stored triglyceride Into free fatty acids Anglycerol and release it and you can lose weight So get the insulin down and it all works.

1:34:48So the question is what makes insulin go up Well two things we're fine carbohydrate and sugar. Those are the two things that make insulin go up In addition, branch chain amino acids make insulin go up as well Lucie nice lucing valine which is in corn fed beef chicken and fish process food All right Here's here's here's the deal in one concept My colleague Dr. Carlos Montero who is a professor of public health at the University of São Paulo has done the world a great service He has developed a system for categorization of food processing It is called the Nova system It just means new but he is basically categorized every food Anywhere in the world into one of four classes Easiest way to explain this would be an example.

1:35:41Let's take an apple Nova class one would be an apple picked off a tree Nova class two would be apple slices Destem deceded de skinned maybe Nova class three would be apple sauce Cooked macerated possibly at the preservative added maybe some extra sugar maybe not Nova class four would be a McDonald's apple pie Now does that McDonald's apple pie look anything like that apple No Is there even any apple in it maybe a tiny bit maybe a tiny bit? You know, it's all flavor enhanced etc Okay, turns out This is epidemiologic data, but nonetheless prospective epidemiologic data. So it's not useless That Nova class four that ultra -process food category which is 73 % of the American grocery store Is the class that is associated with all of these chronic metabolic diseases?

1:36:44Nova class one through three No problem. No when you say associate what percentage of ones daily total caloric intake needs to come from Nova class four before that statement You just made is true because it I love the recommendation you made earlier or that let's just say the the contour of You don't have to Avoid dessert you can enjoy dessert, but don't eat dessert at other times of day Right, and maybe you don't eat dessert every single night Is there a rule that people have to eat dessert every single night? So the answer is about 7 to 10 percent Would be the upper limit So you can get 7 to 10 percent of your caloric intake daily caloric intake from these Nova class four foods and still Still be okay.

1:37:29It's still be okay. Yeah, so this is I know That's not what's happening right. I know some very healthy physicians who I used to Observe how people ate and moved because I would pay attention in my Now we're field right I was like, oh, you know people all around me at Stanford UCSF It's ever more successful or else they wouldn't be there I was like, you know who looks healthy who can make it up the stairs and doesn't have to take the elevator How much exercise are people doing at a given age are they fanatic? You know like four in the morning runners I'm not gonna do that consistently unless I have to um And I observe that you know many of the healthiest people I know they move a lot during the day.

1:38:05They hate Very well many of them skip breakfast or lunch not always and then I also noticed that they would Drink very little or no alcohol and then but they would enjoy like a There's one physician at UCSF in particular I'm thinking of who really enjoyed his dark chocolate kickcat after lunch and he sort of very ceremonial about the unraveling that The foil and the in the thing and it was like okay, so you're talking about that small percentage of calories If that's if that's all you do hey, you know god bless you, but that's not what people are doing That's the problem Bottom line That Nova class four is where all the action is in terms of chronic metabolic disease So the question is how can you avoid that?

1:38:49How do you know which is which we have a solution? So my colleagues and I have developed a web -based tool That is available to the entire world right now and you'll put it in your show notes. Yeah, we'll put a link to this absolutely It's called perfect P -E -R -F -A -C -T and you can find that it perfect .co and What it is is it's a recommendation engine Not AI we're going to talk about AI in a minute But it is a recommendation engine based on the science of human metabolism that categorizes foods based on not their nutrient content But on their metabolic effect Interesting and so there is a Nova filter Which will filter out all the Nova class force stuff and it will go to your grocery store And we'll tell you what you can buy that will be a Nova class one through three Which turns out to only be 20 % of the grocery store.

1:39:57I mean it means basically saying on the periphery of the grocery store That's general in general. Yeah, yes produce the meat the dairy the all the things you mentioned In fact, so I'm not low carb I'm low insulin and there are a lot of ways to get to low insulin get rid of the refined carbohydrate get rid of the sugar Increase the fiber Get rid of the branch chain amino acids Okay, so eating fish is a good place to be Even eating a steak is okay If it's a pasture fed steak, so let's talk about your steak You also better for the animals, right? It is absolutely. So you mentioned marbling before We love our marbling right we can cut our us grade A stakes with a butter knife because they're so tender Right You ever been to Argentina?

1:40:48Yeah, my father's Argentine. Oh right. That's right. You're Argentinean. Yeah, they only know of course They only know grass. Oh the idea that they cows would eat anything but grass is sort of like the idea that um Then those are bad would would fly absolutely New Zealand's same thing. Yeah, okay The meat is gorgeous. It's homogeneous. It's pink. It's the the life. I've been to Argentina The meat is fantastic, but you have to use a steak knife. You can't use a butter and it takes more chewing And it takes more chewing because it's a sinew that you know, it's a it's a different experience entirely It's delicious, but it is kind of a little bit, you know tougher All right Turns out that marbling is intramiosellular lipid That animal has metabolic syndrome the American corn fed the American corn fed animal because that corn is filled with branch Shane amino acids loose and isolucine valine branch Shane amino acids or what's in protein powder?

1:41:45That's what um, you know Bodybuilders, you know put in their smoothies, you know to build muscle and if you're building muscle that's okay because 20 % of the amino acids in muscle are branch chain So you know if you've got a place to put them You know have at it. Yeah, there's a need there because the making down must have fun But if you're not if you're you know again a mere mortal like me you consume those excess branch chain amino acids They're going to go to the liver. They're going to be de -amidated like we talked about earlier and they're going to end up as branch chain organic acids They're going to flood the mitochondria they mitochondria not going to be able to deal with the volume and so they're going to divert the excess and turn that into fat and so now you've got hyper triglyceridemia and Chance for fatty liver disease and insulin resistance.

1:42:38So What kind of meat you eat has a lot to do with your metabolic health? What about the egg the whole egg near near perfect protein score in terms of its um bioavailability Exeterrific. Okay. There's nothing wrong with eggs now. There are better eggs than others. So that's true. Well, there's yellow Yoke eggs and there orange yoke eggs. What's the difference between a yellow ocegan and orange yoke egg? I'm guessing that something about the the feed of the the mother chicken And I'm guessing it probably also has something to do with Colleen content omega -3s. Ah interesting. Okay, the orange Yoke egg Has a lot of omega -3s in it.

1:43:28What are other great sources of omega -3s? I know some off the top of my head, but I'd like to hear it from you. Okay, so marine life is number one. Okay, um, you know fish Provided you're not bringing in heavy metals with it. Well, yes. So I mean that's always the the the argument You know the question is you know is it the mercury is the omega -3s and ultimately I think it's the omega -3s that is more important But yes, I do understand the mercury issue Um Ultimately, there are three omega -3s. There's ALA alpha Linoleic acid which you can get in vegetables There is EPA icosopentaninoic acid Which you can only get marine life fish oil, cod liver oil Right and finally DHA doko hexaninoic acid Which you also get from marine life, but you can get from algae so you can get algal oil Which you know the vegans will use do you um personally take anything to increase your omega -3 and take yeah I know there's even prescription omega -3s.

1:44:34I take for sure you take official. Yeah. Yeah I the I only take three I only take three supplements. Okay. I'd like to know what those are I will say that I always always always say behaviors first right do's and don't behavior nutrition Then Only if needed and one can afford it then supplementation of prescription drugs and I'm a big consumer of supplements and always have been frankly So what are the three so you take Fish oil and do you take to get above a certain threshold of EPA? Yeah about a thousand milligrams. I say about a gram a day Okay, um vitamin C How much of vitamin C do you have a thousand milligrams a day you in line is Pauling?

1:45:09Yeah, well, it's actually from my rosacea. I've got um Skin issue and the healthy helps with helps with that interesting and finally vitamin D Now I will tell you vitamin D is a complicated one All right Let and we can talk about vitamin D and how Either important or non -important it is because there's a there's a quirk to vitamin D and It's important for your audience to know about it because everybody and his brothers, you know Touting vitamin D It's sort of funny because then you have your supplement lovers haters and agnostics But vitamin D somehow made it through the shoot Like everyone's like pro vitamin D.

1:45:51It's really interesting somehow vitamin D People are comfortable taking a jet vitamin D gel cap But like other supplements where you say oh like maybe um, this might be good for You know like omega -3s and fish oil them people are a little bit like more standoff. It's really interesting that the kind of psychoso Social stuff around this how much vitamin D do you personally take I take 5 ,000 units a day. Okay, so do I vitamin D's complicated though Here's the problem if you look at the literature vitamin D deficiency is associated with all these chronic metabolic diseases However supplementation With vitamin D has not fixed any of those So if you're vitamin D deficient why wouldn't supplementation fix it?

1:46:40A couple of reasons one one of the reasons for vitamin D deficiencies because everyone's drinking soft drinks That's one reason, but there's a more important reason sugar and artificially sweetened soft drinks. Yeah, can deplete vitamin D. You will is it well. You're not consuming dairy because you're consuming soft drinks But I can't tolerate milk anymore Well, then you take vitamin D But here's the here's the real nugget of truth and this is a little complicated, but the endocrinologist and the audience will get it vitamin D is a pre pro hormone It's not it's not active at all Vitamin D is converted in the liver First step to a compound called 25 hydroxy vitamin D That is a pro hormone.

1:47:29It also is inactive. It has no activity whatsoever From there 25 hydroxy vitamin D can be metabolized one of two ways It can either be one alpha hydroxylated in the kidney to the active form one alpha It's one 25 dihydroxy vitamin D which will then do all of the business of vitamin D such as calcium absorption from the gut suppression of the immune system at the toll -like receptor 4 that sounds like a bad thing No, that's a good thing. I know, but I had to bring that up because when you say suppression of the immune system People are my immunosuppressed nobody that sounds like aids a good it suppresses inflammation.

1:48:12It's a good thing Okay, suppression of the inflammation and that's actually the point that we're getting to so there are a lot of good things About 125 dihydroxy vitamin D However That 25 hydroxy D that came out of the liver can be metabolized a different way It can be 24 hydroxylated in inflammatory tissue Like tuberculosis, sarcoid gut inflammation And so you will end up taking your 25 hydroxy D which is a pro hormone and turning it into the inactive 24 25 dihydroxy D which then just gets excreted out So in other words you consumed all this vitamin D and it didn't go where you needed it to go and the reason was because you're inflamed You have to fix the inflammation before the vitamin D can be effective And 93 % of Americans are inflamed So Giving them vitamin D Is not going to do a damn thing.

1:49:21Got it. Is reducing fructose intake that one of the primary ways to reduce systemic inflammation? Absolutely. What are some others? Reducing oxidative stress in general. So heavy metals like cadmium You know cadmium is very high in chocolate, especially South American chocolate. Sorry I'm not a fan of chocolate. I occasionally like a little dark chocolate, but okay, but um so if people are going to Eat chocolate. They should be careful how much chocolate. They well in the South American chocolate and plus that's chocolate I mean the really good we're gonna be on the hit list of so many industries I mean all I can tell you is I've been on the hit list for a decade and you're you're just one big target.

1:50:01Yeah, right I got it. I it's on my back. You know kicked everywhere. I already got that There are The main thing is to make that gut work right So fiber Chorchane fatty acid production from fiber is a huge you know Boone and reduce inflammation reduce inflammation about improving sleep Is there any evidence that you know chronic slight sleep deprivation can increase inflammation? Well, what it will do is increase cortisol and chronically increase cortisol will definitely lead to Increased inflammation, you know, which is funny because cortisol is usually considered the anti inflammatory but only acutely right chronic cortisol elevation does the opposite if we can contribute to I have this secret Agenda which is not which is not a secret which is that people think cortisol is bad When in fact acutely cortisol does wonderful things provided it's happening at the right time of day Late shifted cortisol bad Too much or too frequent cortisol bad, but cortisol you need it It's so essential and I think most people just hear cortisol and it's been associated with all things bad and and maybe we can help shift that near Yeah, I'm very happy.

1:51:17I mean as an endocrinologist. You know, this is you know, where this is my wheelhouse is where I live Cortisol is a good news bad news deal like so many things short -term gain for long -term pain Okay, so when you are in what we call aloe stasis that is perturbation of homeostasis that is a stress and acute stress cortisol is one of the things that helps you manage that bodily and mental stress. So an English test A car accident Running away from the lion, you know the famous you know Pig me running away from the lion All of those require cortisol in order to manage and mitigate that stress the upcoming 2024 election That's chronic stress I just not acute stress.

1:52:14It's the worst That'll be the only mention of politics. Yes podcast And we don't have to go there but we're all chronically stressed and We can talk about why that is and what's going on and I'm actually very interested in that and a colleague of mine in Paris and I have built a computational model of the limbic system which focuses on the stress center of the brain the amygdala To understand how chronic stress is different from acute stress and how that chronic stress ultimately leads to metabolic and mental health disaster very interested in learning more about that before we touch on that You've worked a lot with kids People age as you put it zero to 19 I don't know about the exact numbers but when I was growing up there were some kids in school that were overweight But it was the occasional kid right Now it seems depending on where one draws the threshold for overweight It seems that there are a lot of kids that are overweight How about 25 % obese And 40 % overweight Okay, so obviously a serious problem serious now and going forward and do what about adults in the US I remember seeing at a meeting a map of obesity in the US and Over time and it very quickly filled in from very few people were obese to very many Colorado was this Was this like like begin of of Of fit people, but now it's no longer and that's bullshit too.

1:53:50Oh, okay. Cool. I'll tell you why there are four things that can increase mitochondrial biogenesis You can tell me altitude is cold. Yeah, that's why Colorado's less obese Altitude that's why Colorado's less obese and What were the other two I forgot but those were the reason it had nothing to do with being more fit It had to do with cold and altitude example Switzerland compared to Germany I got the same crappy food But Switzerland has half the obesity the Germany does I love Switzerland is higher. Oh, I love the food when I go to Munich I love the schnitzel's Wonderful sour crowds and they got that in Switzerland too Okay, so that great food Switzerland's less obese All right, same way Colorado's less obese.

1:54:36It's because of the altitude You mentioned cold many listeners of this podcast are at least interested in some Also practice deliberate cold exposure cold showers cold plunges mainly for the I think the best data are the increases in catacole means up in effort north in effort Don't remain that are long lasting people feel a big state shift. They feel better But when one looks at the effects on metabolism. They're pretty slight. They are slight however studies like that to me always seem um Short -sighted in the sense that if there's a longer arc of effect on the mitochondria that's affecting other things in terms of how calories are processed or how calories are feeding into mitochondrial function or dysfunction There I you could see how it might shift the um shift the scale so to speak I mean cold is is an amazingly powerful stimulus And I think of light cold food movement It's kind of like the core For ways in which you can shift physiology easily all of these things are Emmanently manipulable and for almost zero dollars Okay, but you have to know what you're doing and right now we've been actually kept from that knowledge and You know If you're addicted, it's really hard to unaddict yourself so that brings us back to this thing about um food Industry conspiracies government conspiracies and the rest boy.

1:56:05This is going to be an interesting um we can go section, but What do we do like so if you and I go up to cap capitol hill which I've done yeah, which you've done and and maybe I'll join you someday um And you know your UCSF I'm down at Stanford your clinician. I'm a scientist and public health advocate Podcaster and we explained to people hey listen like there's the food is laced with a drug It's my it's not even really food. It's right. It's not food. It's an aggregate of food and non food parts that make you think it's food It's sort of like telling people hey your kids are you know They're swimming in a swimming pool looks like water But it's actually part poison and it's and it's harming them.

1:56:47It's giving them you know if you say those kinds of things I mean congressmen and women are they're like Reasonably smart people right? I mean aren't they gonna do something about it? No So where is the conflict is it that the food industry has Um the government by the short hairs. That's exactly right and they have them by the short hairs where I mean is it are they lining their pockets? I mean where where is the leverage acts that actually exerted? Okay, so they are lining their pockets That's number one that is absolutely true We have the data to support that Blanche Lincoln who was the senator from Arkansas?

1:57:21Who was the chairman of the nutrition committee? You had to see her campaign contributions every time she was up for reelection So it's all about getting reelected or it's about them like having a like a third home in the Hamptons I think it's the third home in the Hamptons. Okay, wow. Okay, so it's really as bad as it is as some of the documentaries without make up believe without question and we and we have the data there is a An organization that I absolutely want to call out because they are you know the most egregious Organ, you know a political organization on the face of the earth They're called the American legislative exchange counsel Alec or Alec and they write bills They are a bill mill Okay, and they are for whoever gives them money and who gives them money Big pharma big agra big oil and Big food and you're so you're including big pharma your physician you've written scripts before you've written Prescriptions for patients before isn't that pharma that provides the drugs that allows your patients to feel better Well, the question is do they do they feel better?

1:58:25This is a big question. Let's you want to go? But you're writing the script. I mean, I mean, I'm just trying to I'm not trying to I'm not you but I see so you don't There have to be instances where someone's thyroid deficient and you give them you know, absolutely So if so if if you've got a disease and a medicine will replace what's missing? Sure, okay? So for the deficiency diseases, which as an endocrinologist, that's what I do Absolutely, and I did that you know with no compunction of Imperpriety whatsoever, but that's not what we're talking about here Let's talk about what we're really talking about Let's start with statins Staten's lower LDL Okay The statins reduce heart disease Yes or no You know, I seem to be whipping today on all the quizzes and it's kind of becoming fun for me at this level I'm gonna go with no, but but I will say you know my friend and I think is it expert Physicians well, you know Peter Athea and others you know has talked about some of the positive attributes of statins in certain cases for certain cases certain cases that's exactly right and I completely agree And by the way Peter's a friend and you know, we some day will we'll you know All you know go out drinking together.

1:59:48Well, I won't drink putting all right. Well, how about we share a state? Shares to absolutely okay, you got it you guys I don't know if you drink so little if you're listening okay, he drinks a little I don't sound me. Yeah, I don't do the dessert or the or the alcohol anymore, but I'm and it's not so I can live to be 120 So I can wake up the next morning and and Keep up with you guys. It's fine. I get The so for primary prevention that is your LDL's high you need a statin that's primary prevention You haven't declared yourself you haven't had an event for primary prevention The mean increase in lifespan for being on a statin is four days Four days four days four days And that's a chocolate that's that's uh and the risk for diabetes is 20 % increase what about any improvement in in quality of life done for primary prevention now for secondary Prevention for secondary in other words, you've already declared yourself you already have a problem For secondary prevention, that's where statins shine So there's a value to them.

2:00:56I'm not arguing that and if you have familial hypercholesterolemia, which is one and five hundred Okay, not only do you need a statin, but you need a low -fat diet and a priest Okay, so there is definitely a value to statins, but not for primary prevention, but that's Whatever whatever doctors doing. Oh, you're LDL. It's over 80, you know, you need a statin That's ridiculous. That is absolutely a joke and the data Show that In fact, in fact my colleague has seen melhotra in the UK participated in an analysis where they took the entire UK population And they took out everybody under age 65 So you're looking at people 65 to 90 and it turned out that the LDL level Correlated with longevity the higher the LDL the longer they lived When you took out all the people who had problems So LDL is not really the problem and the reason is because there are two LDLs There's one called large boy into there's one called small dense Turns out dietary fat raises your large buoyant your large buoyant is irrelevant It is cardiovasculately neutral But that's the one that statins affects The small dense that's the atherogenic particle when your small dense LDL is high That means you are not clearing triglyceride Preferably because that's what small dense show you that's that that's what happens to triglyceride Is because they become small dense can I take a guess and say That the best way to reduce small dense is to reduce insulin Yes, by reducing sugar Because that triglyceride is made in the liver it's all pulmitate and that's the only Fat that the liver knows how to make and so triglyceride is your liver output of Carbohydrate That's how you have to look at triglyceride so triglyceride turns out to be much more important As a cardiovascular risk factor than LDL ever was so does the does big pharma and big Food do they know all of this yes?

2:03:13I know they know because they've told me so and but they have statins to sell And foods in the The Nova class for They know this too. So you know, I'm an optimist or you know what What's it going to take to really move the needle? I mean you just grab the four barriers um, we're trying to add to the knowledge component now um You know, what's it going to take is it going to take uh, you know having a president in office or Congress people in office that really understand and care about this stuff Yeah, I mean to really revamp the whole system. Yeah So right now the system is completely and early broken Completely and early broken and there's a reason why it's completely and early broken because the food industry likes it that way Well, it's profitable for them obviously.

2:04:06There are 51 different federal agencies that manage our food 51 and none of them know what the other one's doing And the food industry likes it that way. So communication across these 51 Organizations would help well if we had a centralized food Zore or food, uh, you know if we split the food off the FDA because you know, it's like It's not the FDA. It's the DA or the FDA is not the food and drug administration It's the federal drug administration. They spend a lot of time on drugs They spend almost no time on food. Well, let's think about where there's been success. So I can recall when people smoked on planes I actually recall going to a gym in Europe and there was an ash tray molded into the squat rack.

2:04:55Yep That was telling. Yeah I don't see people smoking cigarettes around Stanford hospital anymore But I remember when they initially said that people couldn't smoke anywhere except in with this one little designated area And that's typically what you see nowadays and my understanding of the Anti -smoking campaign at least for kids for people 18 and younger was that telling people it was bad for their health Didn't work that's showing them lungs that were decrepit didn't work didn't what worked was showing them commercials of cackling handwriting White guys who were talking about how much money they were making off of these um naive kids who were buying cigarettes another tobacco product.

2:05:40So it became a The the effective campaign to end smoking in young people was to hijack their Inherit rebelliousness of youth and then they were like no Stick it to the man stick it to them like it with you know that the as my friend calls it like the two bit the two finger business car No, and so That worked that worked Things making a comeback we vaping is a separate episode. We won't get into that but yeah because nicotine is still addictive, but You don't see a lot of people smoking cigarettes. So it works like something that you would never imagine could ever work worked Well, so yes, no, I mean that's part of it.

2:06:20I'm not gonna tell you that it's not it is part of it And we actually have an example of how that could be applied to another Tox exceptions sugar. We had Berkeley versus big soda You know, that's how Berkeley ended up with its soda tax that dates back to And fifty a Berkeley city of Berkeley It we just celebrated the five -year anniversary of the Berkeley soda tax and we've been able to actually look Justational diabetes way down obesity down slightly not a lot, but a little bit um cardiovascular disease down Dean Schillinger and Chris Madsen at UCSF And you see Berkeley just presented at San Francisco general just three weeks ago So a soda tax like the cigarette tax like this makes so too expensive exactly.

2:07:10So you're telling me that a can of coke That I buy on shatic avenue and Berkeley costs more than a can of coke that I buy in on university avenue in palolta It does huh, okay, buy a dime and that was and sufficient enough to to create this kind of change well and yes It is money hurts because money hurts exactly so Andrew there have been four count them four cultural tectonic shifts in America in the last 30 years And they're all undeniable here. They are number one Bicycle helmets and seat belts. Yeah, everybody uses those two smoking in public places nobody does that three uh drunk driving Hopefully fewer people are doing that four condoms and bathrooms Condoms in bathrooms in public bathrooms.

2:08:05Yeah, you see those more available, okay? Yeah, all right 30 years ago If a legislator stood up in a state house and proposed legislation for any one of those four and I don't care if it's an estate house or in Congress or in parliament or in the Duma or anywhere else in the world. Okay, then I got in the left right out The town Nanny state Liberty and trust get out of my kitchen get out of my bathroom get out of my car Okay, today roll fax life All right nobody's belly aching about any of those point is We were able to solve those for Public health debacles. How did we do it? How did we solve those for No one could imagine that we would ever solve smoking right but we did sort of I mean we brought consumption down by half Okay, that's pretty good when you think about it for an addictive stuff How many fewer people are dying of lung cancer nowadays in the US?

2:09:06It's like 80 % lower. Well, there's also been improvements in treatment, but yeah, but no, it's it's the Indicence with the incident incidents gone amazing, okay? Because tobacco's gone down. So the question is how did that happen? The answer is very same. And why did it take 30 years to do it? We taught the children the children grew up and they voted And the naysayers are dead That's how you make a cultural tectonic shift so We now have this real food movement. We have people who are arguing against ultra -process food We have kids who are demanding Different in their schools and by the way What is the biggest fast food franchise in the United States?

2:10:01I'm gonna get this wrong. So try me again. I don't know. I've never tried it, but I've heard of is it chick -fil -a Nope, it's it McDonald's. I don't know It is this nation's public schools. Ah You can add up McDonald's subway Burger King and Wendy's and every other Fast food franchise jack -in -the -box every fast food franchise in the entire country and would only be half Our nation's public schools. Wow. So could you imagine a world where there were no Class three or class four Nova foods allowed in In public schools and we're doing it So I am the chief science officer of a nonprofit and put this in the show notes called eatreal eatreal .org and we have a new business model for public schools So in 1971 The Department of Education issued an administrative ordinance called resolution 242 And they did this purely on monetary issues reasons this was under Nixon and what this resolution 242 said was that all school cafeterias All throughout the country had to make book They had to basically cover their costs.

2:11:33They couldn't be lost leaders for the school They had to fend for themselves Well, this sent every food service director in the country Scurrying for you know, how am I going to do this because I got all these you know You know lunch ladies, you know, which you know personnel and and food preparation equipment and and and costs you know that they're you know mounting how am I going to break even They couldn't do it. So in walks, you know, Aramark and Cisco and Guggenheim and McDonald's and they say hey, we'll do it for you Will provide every kid in America with a nutritious meal every single day hot lunch Well, they didn't say hot okay, they just said lunch okay nutritious.

2:12:22They said nutritious And I put that in the air quotes too because it wasn't nutritious And here's the added benefit You can take your food preparation facilities and your Footprint in the school and you can turn that into classrooms because you're gonna need them And that was the goal Because as soon as you've moved the food preparation facilities out of the school You're now hostage to the food industry for the rest of your life And I could also see how that allows room for them to use these commoditized foods foods that have very long shelf life Exactly right because you want to make sure that you know if you only sold You know two -thirds of the lunches that were prepared that on Next Tuesday after the weekend You could still give them food that isn't moldy exactly right and I will tell you so that's how it happened And you can actually trace IQ scores and reading and math scores in this country down from 1971 to today When I went to school I was allowed to get I called it hot lunch because it was usually hot it was Allowed to get the school lunch one day a week one day a week other days.

2:13:34I had to bring my lunch That one day was pretty special like you felt like you were getting a treat was usually like a corn dog Or a hamburger the hamburger was pretty poultry but the um it's a commoditized hamburger. Yeah, commoditized hamburger You had to go looking for the patty portion And the bread was sweetened and so it was different right But um, I don't remember nearly as much obesity. I went to to high school in the early 90s um, so you're saying that now if I went to a high school it would be a lot more sodas and donuts and oh pizza and got it. Yeah, pizza is a vegetable didn't you know It's they claim it's a vegetable congress said pizzas of etch double Amy Klobuchar made pizza of etch double Maybe they need their eyes because the biggest frozen pizza Uh, producer is in Minnesota.

2:14:23I mean ketchup is a vegetable was it was a was a stretch But at least it made sense on the Nova system of to going from tomato all the way to To catch up to catch up since high fructose corn syrup is the primary ingredient in ketchup Indeed, so the point is that our kids are suffering under the weight the burden of this chronic disaster Of ultra -process food, which is not food and no wonder they're all obese and uh, uh, sick and uh, you know doing so poorly in school and by the way also depressed ultra -process food has now been shown in three separate studies To correlate with depression in teenagers So what is the relationship between Process food or maybe we call it Nova system level three four foods and depression and other psychiatric challenges and If you could you separate out metabolic syndrome from obesity um in answering that like like is there something inherently depressing About carrying excess adipose tissue setting aside any kind of aesthetic um Uh stuff You know how people want to look or are perceived you know, just is there anything bad about carrying a lot about body fat Independent of the metabolic syndrome is it for mood and and overall sense of well -being?

2:15:50No, I'm really glad you asked that Andrew and we should have actually covered this earlier um Everyone thinks fat is fat As we've learned fat is not fat and a fat is not a fat but um body fat is not body fat There are three fat depots and they are Metabolically different first is the Does this bathing suit make me look fat fat by the way never answer that question That's called subcutaneous fat or big butt fat if you will So here's the question how many pounds or kilos of subcutaneous fat do you have to gain Before you become metabolicly ill I'm no idea about 10 kilos about 22 pounds Okay, why the reason is because that subcutaneous fat drains into the systemic circulation So you have to have a lot of cytokines coming from those subcutaneous adipocytes to raise the blood level Of cytokines to the point where it starts doing damage at the level of the litter So fats are releasing cytokines which are pro -inflammatory exactly and then they're doing that at rest any fat cell any fat Okay, any fat cell but if it's going to the systemic circulation you have a volume of distribution of six leaders So you have to lose you know, you have to have a lot of cytokines to get the concentration up now just out of fairness to the fat How many cytokines does a muscle cell release?

2:17:31I mean are we unfairly picking on adipose tissue because why would adipose tissue be pro -inflammatory? I mean a single fat cell Wait, okay, I've got a fat cell sitting in my shoulder someplace right? I mean, I'm not zero fat at my shoulder. Why would it be pro -inflammatory? So in fact the fat cell itself is not Here's what happens The fat cell has a fat vacuole it has a storage place for this lipid droplet You stuff it you stuff it you stuff it the fat vacuole gets bigger bigger bigger the perilipan border that encompasses that fat vacuole that borders the the the space ultimately can't Get any bigger and it starts breaking down when that happens It spills the grease into the fat cell the fat cell dies Becomes no product that calls macrophages in to clean up the grease and it's the macrophages That release the cytokines All right, so in fact the fat cell is not the problem.

2:18:42It's the breakdown of the grease That leads to the macrophage activation. That's the problem But when you do it in subcutaneous fat It's going into this six -liter tank and so the concentration doesn't go up very much So 10 kilos before you start seeing some effect Fat depot number two Visceral or big belly fat Now how many pounds or kilos of big belly fat do you have to gain before you get metabolic? I don't know but I'm guessing it's less than 22 pounds. It's way less Oh for once I got an answer right today. That's right About five About five pounds now questions. Why? number one The visceral fat does not drain into the sub into the systemic circulation It drains into the portal vein which goes straight to the liver.

2:19:44So you're getting a bigger load going straight to the liver of cytokines Not to the kidney not the good thing about getting an answer wrong folks is that you never forget the correct answer That's why I always tell my students right so I'll never forget that indeed got it And the question is what made the visceral fat in the first place? Was it calories? No It's cortisol It's stress It's the combination of the sympathetic nervous system and cortisol and the reason we know this is because you can take patients with major depressive disorder With endogenous depression who are suicidal who have to be admitted to the hospital to keep themselves from killing themselves Stick them in a scanner and they are losing subcutaneous fat like crazy because they're not eating But they're gaining visceral fat because of the high cortisol on the stress So there's something about the adrenocortocorticoid receptors in that area that just preferentially depot fat there when cortisol is high indeed Because that's the metabolically active fat All right, and five pounds will do it and then finally the third fat depot the liver Now how many pounds of fat can the liver store before you become metabolically ill?

2:21:04I Got to be even less because the liver is not nearly as large as the sort of abdominal region half a pound Quarter of a kilo how much does a healthy liver way? Healthy liver weighs 1500 grams Okay, okay So you know, it's not very Trans -translate quickly pounds who we're going to match it we're going as a standard so 1500 grams would be three pounds So you know basically half a pound okay, so not very much Because that's where the action is and so when you have fat in your liver it causes metabolic dysfunction Right away and the question is where did that fat come from that came from alcohol or sugar?

2:21:55So alcohol and sugar most metabolically egregious because it affects the liver directly stress Second most because it affects the visceral fat and subcutaneous fat the least important in terms of metabolic derangement So yes, it may not look good in a bathing suit, but from a metabolic standpoint It is actually the least important so the question then becomes all right What are you trying to fix? If you're trying to fix liver fat It's really easy get rid of the alcohol in the sugar except of course they're both addictive Well, that also liberate any fat that's already in the liver absolutely And that's one of the reasons why intermittent fasting works is because it gives your liver a chance to basically offload What it's already stored That's one of the things that intermittent fasting will buy you is a little less liver fat So that's a good thing Now stress on the other hand as you know and as we've talked about and as you know you've had I'll doctor at Liseple on your podcast before you know stress is tough You know trying to mitigate stress Especially in today's environment and I hope you'll invite me back some time to talk about the role of stress on the amygdala now gladly um And then finally, you know subcutaneous fat so when people go on diet sweeteners What are they doing?

2:23:31Are they really reducing the fat and the answer is no We didn't talk about artificial sweeteners diet sweeteners of any sort you can pick your artificial sweetener so a spartane or you know sucrose sucrose stevia stevia monk fruit of uh The new ones, you know, yeah, the one that people are more excited about nowadays is aloe aloe It's expensive it tends to have less of an artificial sweetener taste that people can detect Right um, so you're saying that regardless of oh and we should uh, I'm remembering From the comment section. I do read them artificial sweeteners and non caloric sweeteners. Yes, because in what the moment you say artificial people say what about stevia what about aloe So so let's just say um Non caloric sweeteners can wrap our arms around all that entire category Unless we need to distinguish among the different participants in that category So you're saying that even though people can Lower their total caloric intake pretty effectively.

2:24:35I've seen the studies that show if you know Dieters who consume Water only as their you know main liquid versus Diet sodas with aspartame typically or stevia The diet soda drinkers actually lose more weight We know that but you're saying there may be deposition of fat in the liver in those individuals Be specifically because of the artificial sweetener because of the insulin turns out They're still in insulin response. So very very famous study done in uh Copenhagen 100 normal individuals 25 and four different groups one group uh One liter of sugared soda per day for six months one liter. That's a lot of sugar.

2:25:23So yeah One group one liter of diasoda per day for six months. I probably did that in graduate school One group one liter of milk per day for six months. I probably did that when I was an infant And finally one final group one liter of water per day for six months. I do that now I do more than that, but yeah the one liter of soda per day In six months gain ten kilos the sugary soda the sugary soda ten kilos. Okay, no surprise The one liter of water per day Lost two kilos Also no surprise those were the easy ones now. Let's do the ones in the middle one liter of milk per day No change Presumably that was full fat milk.

2:26:11We're all full fat milk. Yeah, they like their their yeah full fat milk No change. Why is that They're taking on an enormous increase in total caloric intake. I'm guessing that there was a Blunted insulin response due to the fat in the milk and also because lactose is not a very uh Big driver of insulin response and because There's a satiety effect. That's like food. It'd eat less. Yeah, it's like food like food And finally the key the kicker to the whole thing diet soda The one liter of diet soda. What what would you predict? Their weight would do More weight loss than in the water group based on my understanding of the literature they gain two kilos Wild because they eat more Well, you tell me Why did they gain two kilos if they were consuming a liter of Dio soda which are zero calories The answer is because they still generated an insulin response and that insulin response generated more hunger more more weight and more hunger Exactly and that's the key so if they didn't gain the ten kilos they gained two kilos.

2:27:24So it looks better compared to the sugar uh uh version But it looks like you know a problem compared to the water version or even the milk version So unless you bootstrap calories and hold that constant you're gonna see a weight gain due to artificial sweetenery and exactly right And that's been shown 50 ways from Sunday at a whole bunch of different studies So compared to sugar. Yeah, it's better But compared to water it's way worse and the reason is the insulin response You put something sweet on the tongue message goes tongue to brain sugars coming message goes brain to pancreas through the Vegas nerve sugars coming release the insulin and so tongue doesn't know if it's sugar or not It releases the ends that pancreas releases the insulin which drives energy into fat whether it was you know from the Diet sweetener or not I saw some really interesting data from Dana Small's group at Yale Yep showing that when people have a diet soda with food So this is like the diet coke with the sandwich or with the burger maybe even with the pasta The insulin response from the food and the insulin response from the diet soda are compounded But there's a classical conditioning effect Pavlovian effect such that then later if they Just drink the diet soda they get an even bigger insulin response just to the diet soda than they would have Originally if they only had the diet soda separate from food So in other words the the insulin the food -induced insulin response is conditioning a greater insulin response from the diet soda And we actually have another study that demonstrates the same thing out of Singapore Tay at all in the American Journal clinical nutrition in 2018 I believe That looked at a similar paradigm here's what they did They took a bunch of people and they admitted them to their clinical research center Four times a week apart and they did have been random order and each time they Started the morning they're fasting and they did either a sucrose tolerance test or an aspartame tolerance test or a sucralose tolerance test or among fruit tolerance test So two hours you know ingesting one of the three one of the four and measuring glucose and insulin over the course of the next two hours fasted fasted okay, okay Then it was time for lunch and they let them have Whatever lunch they want it was a metabolic buffet they could eat whatever they wanted off the buffet except that they were being clocked And the same for dinner they were being clocked But they could eat whatever they want in a given period of time in the 24 hours, okay, and you know Or you know from 7 a .m.

2:30:14to 7 p .m. Whenever they went home, okay turned out The sucrose tolerance test generated an insulin response as you'd expect the Monk fruit the steep the sucralose and the aspartame did not But then when they ate lunch They If they had had one of the three diet sweeteners in the morning They ate more at lunch and more at dinner and generated an increased insulin response both at lunch and dinner So that the area under the curve for the whole day was exactly the same So they ate a significantly more Yeah Yeah, because they had the diet soda in the morning wild well I drink And Drinks that contain stevia And I don't worry about it too much But what you're saying is even if I Foodstrap my calories there's a possibility that the insulin response could have direct effects on the liver exactly right and not for the better and not for the better now having said that Um, we have undertaken an interesting project which I don't know if you know about um In 2020 during the pandemic I was approached by a food company in the Middle East Called Kuwaiti Danish dairy company KDD.

2:31:38It's the Nestle of the Middle East Now they make all sorts of junk frozen yogurt flavored milks ice cream confectionery biscuits tomato sauce, okay So Kuwaiti has an 18 % diabetes rate and an 80 % obesity rate 80 80 wow in the adults, all right now The company recognized that they wanted to be a metabolically healthy company and they knew they weren't They contacted me and said would you put together a scientific advisory team to Advise us what we need to do to change the food in order to be a metabolically healthy company and we want to lead And I said we'd be happy I'd be happy to do that with one proviso we get to publish What we did so that it can serve as a road map For the rest of the food industry and they said fine and so I convened a scientific advisory team with my colleague Wolfram Alderson who started the very first farmers market in Los Angeles and is now actually the director of sustainability and nutrition for KDD Tim Harlan who is the head of culinary medicine at George Washington University Rachel Gow who is a fatty acid expert who ran the omega -3 for ADD trial at the NIH and Andreas Cornsch dot who's actually a computer scientist from Stanford and we basically stripped down every single thing that KDD did in terms of procurement in terms of ingredients in terms of packaging We submitted every single ingredient to biochemical analysis because you couldn't trust What the vendors were basically telling KDD was in the food we had had to actually know what was in the food And that was a half a million dollars all by itself.

2:33:38I mean this was not a cheap little you know Sojourn into the woods. This was a big deal We basically re engineered their entire 180 item portfolio and they have now turned over 10 % of their products to be metabolically healthy and The precepts that we set in this paper which is in frontiers in nutrition in March of this year 2023 Three things three principles if you adhere to these three principles you can turn any Food healthy including ultra process food Number one protect the liver Number two feed the gut number three support the brain If you have a food that does all three of those it is healthy If you have a food that doesn't none of those three then it's poison because it's not food It's not I was gonna say it doesn't sound like food is the right um the right descriptor in that case exactly And if it's does one or two but not all three then it's gonna be somewhere in between So the goal was to take all of KDD's products and move them from You know the lowest tier up to the highest tier by adhering to these three principles And we came up with some very simple things number one got to get rid of the sugar number two Got to add fiber Number three got to add omega -3s Number four Got to do something about the emulsifiers Because the emulsifiers are causing the gut inflammation because after all emulsifiers are detergents They hold fat and water together they burn a hole in the mucin layer So they're actually contributing to that gut inflammation and emulsifiers are you know strewn throughout ultra -process food them We've heard about hidden sugars a lot During today's episode and elsewhere, but based on everything you Told us about artificial Excuse me low calorie sweet nurse um It makes more sense to be now why foods that are not touted as diet foods Would be laced with things like sucralose because it should drive the craving for that food through increases in insulin and craving of other foods Later that day and later that evening is that why Non -chloric sweeteners are added to all sorts of foods now that because typically one thinks non -chloric sweeteners Probably only added to quote unquote diet foods low calorie foods, but that's not that's their own right That's not the case and they are adding diets diet sweeteners to foods that you didn't know had diet sweeteners in them.

2:36:16That's right um There are two reasons that this happens one is insulin because insulin blocks leptin signaling at the level of the hypothalamus and the nucleus accumbens so with the blocks leptin leptin is the hormone that your fat cells make the tells your brain You've had enough So if insulin blocks leptin it makes you hungrier and it also extinguishes it stops the extinguishing of reward By that food so that you want more of it So it does both because leptin normally suppresses food intake and reduces craving the analogy that comes to mind is um a slot machine that encourages you to feed more money and hit go to pull the lever But it also blinds you to the outcome so even if you win you don't even know that you have wins It's also blinding you to your losses You're effectively becoming a haumaton yeah of just eating without any um Kind of conscious understanding of what you're you're bringing in or tasting the food any longer exactly right It's not this like an anilemmke when she came on the podcast author of dopamine nation and obviously had a or a dual diagnosis addiction clinic talked about You know these these consumptive behaviors where people are scrolling social media or consuming porn or Consuming drugs or alcohol in a way that like they're not in touch with the pleasure of the of the substance or behavior anymore They become a taumatons, but they but if they don't do it they feel lousy So the pleasure is gone the pain is definitely awaiting tolerance and dependence That's the definition of addiction So dopamine is an excitatory neurotransmitter It excites the next neuron always there's no such thing as dopamine Inhibiting a post -emaptic neuron dopamine stimulates the next neuron And it doesn't matter which dopamine receptor it is one through five.

2:38:11It's always excitatory Now there is like to be excited. That's why they have receptors But there is like to be tickled not bludgeoned Chronic overstimulation of any neuron and you know this leads to neuronal cell death And the reason is because the neuron needs energy the neuron is the most energy dependent Tissue in the body it needs those mitochondria to be pumping out ATP like crazy To engage in neurotransmission well when you're firing nonstop You risk cell death So the excitatory neuron the the post -emaptic neuron has a plan B It down regulates the receptor it down regulates the dopamine receptor So there's less chance that any stray dopamine molecule will find a receptor to bind to And this is its plan B in order to try to mitigate the risk of dying Well, what does that mean in human terms?

2:39:18It means you get a hit you get a rush Receptors go down next time you need a bigger hit to get the same rush I'm receptors go down and you need a bigger hit and a bigger hit and a bigger hit until finally you need a huge hit to get nothing That's called tolerance And then when the neurons do start to die that's called addiction That's what we've got And that's what's happened in terms of food addiction so The question is what's addictive Is fat addictive no Because if fat was addictive then all the people on the Atkins diet or on the ketogenic diet would be gaining weight not losing it And I'd be craving revise all day I like a revive pretty often actually, but I know I know people say no Look my lipids are in in line and I I don't eat many starches it and I certainly avoid sugar Although now I'm thinking I might want to really reduce my Low calories a sweetener intake.

2:40:13I don't see myself reducing my stevia intake to zero Because it's in some things I really like Andrew. I am not the food police You know, I always say that I'm not a cop but the um But but but data are data and and health data are the data say that That's not helping you any that's what the data say um Point is that The fat's not the problem the salts not the problem The caffeine's a problem Real caffeine's classic addictive substance at every level. Yeah, but and the server's a problem But if one can cut out caffeine by the early afternoon or even sooner in the day and it's not consumed to excess Um, and it's in the former coffee your bramate some other form that's healthy You know, is it really that much of a problem?

2:41:07Um, I love coffee Me too. That's my addiction like with a capital L underlying boldface. I like you I I I feel your pain and the answer is no one has shown that coffee is toxic It is addictive, but it's not toxic now if you mix the coffee with alcohol Now you got four loco now it's toxic, but in and of itself caffeine is not toxic and that's why there's a Starbucks on every street corner But it is highly reinforcing. I did an episode on caffeine where That covered some data that was published in the journal science one of the three apex journals um and If you put caffeine unbeknownst to the consumer into plain yogurt People will crave plain yogurt indeed much more I mean people like the feeling of being caffeine as long as it's not creating anxiety levels of energy Exactly.

2:41:59I'm gonna stick with caffeine. That's fine. Yeah, and so why We've been talking about a little bit about the hypothalamus as well as some peripheral gut -based mechanisms for hunger and satiety Um, this is a great opportunity to talk about some of the GLP1 agonists that are now um widely used so thing typically called ozempic but GLP1 Gukuk on like peptide one right originally discovered in the heli monster which eats very seldom and some really smart biologist I love biology like this. I said how come they don't have to eat very much? Well they have their blood is loaded with GLP1 Um, and so they only have to eat one whatever heli monsters um Delighten per year or something outrageous like that humans make GLP1 as well My understanding is that GLP1 that That not that's injected, but that one makes naturally Is acting on both the brain and the gut to increase satiety So is acting on the brain?

2:42:59No argument But the primary action is on the gut GLP1 decreases the rate of gastric empty That is its primary driver. Yes, it does affect the brain. I'm not arguing that it does But the primary effect is to reduce the rate of gastric emptying So you stay fuller longer because the food doesn't move through the stomach and the intestine interesting in South America And Uruguay and Argentina it was long thought that um Year Brahmate consumption which we know very modestly increases GLP1 like and by the way a lot of other things do too Um That people were taking it for its After meals for its laxative effect partially that's you know, it's not pleasant for that's that's the colon That's at the level of colon but stomach but it is used fairly effectively for people to space their meals without snacking That you're you know, and maybe it's the GLP1 maybe it's something else But people are injecting themselves with GLP1 Analogs now Act in the $1 ,300 a month.

2:44:06Yeah, is that what it costs? That's what it costs right um And it seems to be pretty effective at inducing weight loss although a significant amount of that weight loss seems to be from A skeletal muscle tissue and we need to talk about so what are your thoughts on those M -PIC as a primary Earlier you talked about primary and secondary control. Are you referred to it a little bit differently in the context of statins? Um, so a kid comes in his obese or slightly overweight And it's like, I don't know what to do. I'm trying to eat better exercise or a person comes in says Hey, I've had a really hard time getting that last 20 9 pounds off for so many years.

2:44:40Yep. Will you prescribe me those? So the short answer is number one. I'm retired so I'm not to prescribe anything But let's let's let's let's go with there the data show that GLP1 analogs like Semaglutide and now Terzepatide which is lilies version Monjaro is the diabetes version zep bound is the obesity version in the same way that ozempic is the diabetes version for Novonortis and wagovie is the obesity version so they're all GLP1 analogs. They're synthesizing lab It looks like GLP1 smells like GLP1 acts like GLP1 when injected Terzepatide the lily1 actually has a dual function it binds to the GIP receptor so it might have double duty and the data show that it's actually even slightly more effective at weight loss than the Novonortis version so we'll be seeing a shift in terms of consumer preference soon no doubt But here's the thing you look at the data one year of treatment 16 % weight loss now that sounds great and I'm not saying it's bad and people are not craving food all the time is that because people are Feeling full longer right so they're eating less they're eating less and so the calorie and calorie out model They're eating less and so they are losing weight I'm not arguing that and they might be craving alcohol less according to some recent Yeah, well, we can go there for a minute too in a second Here's the problem When you look at that 16 % weight loss as you just said When you put people in a dexascanner they have lost equal amounts of fat and muscle now Is it good to lose muscle?

2:46:33No, it was not good Ask any little old lady who breaks her hip if she wish she had a little bit more muscle or somebody who died It lost a lot of muscle because they weren't offsetting the weight loss with resistance training or some other form of exercise and the amount of food that they can eat in order to maintain that weight To put it in scientific terms sucks And You know, we mentioned Peter atia earlier, okay, in outlive. He's made it very clear that sarcopenia lack of muscle mass is one of the drivers of mortality so losing muscle is not a Good idea But you lose equal amounts of fat and muscle.

2:47:13What else causes loss of equal amounts of fat and muscle? starvation In fact the reason that all these glp1 analogs work is because you stop eating like the heel monster Yeah, just like the ill monster the ill monsters look pretty chubby to me well Ask another heel monster. I did but unfortunately whatever answer it provided was not in terms in the point is that starvation is not so good and if you Think about why it's working. It's reducing gastric the rate of gastric empty in All right, well, it turns out that that's the reason for its side effects the reduction in gastric empty That's why you get nausea.

2:47:56That's why you get vomiting That's why you get pancreatitis and most importantly now gastroparesis your stomach turns to stone And you can't move any food through your intestine at all and Worse yet when you stop the medicine The gastroparesis doesn't get better This is not a good idea This is like the opposite of the yearbaumata induced effect which has a sort of pro -laxiv gastrokeptine maybe glp1 agonism gosh, okay, so It's obviously why people who've struggled to lose weight like it Yeah, especially if their struggle to lose weight was at least in their mind the consequence of being hungry all the time and needing to eat more Or was it because of the reward and the you know their dependence because in fact Yes These glp1 analogs reduce reward and that's one of the reasons why they've noticed that you know thing reduction in alcohol consumption As well and that sounds like a good thing except There are also numerous cases now of major depressive disorder in response to these drugs.

2:49:13That's almost like now Trexone or something for the treatment of addiction Well, sometimes can be useful, but now but the attempting to remove the the um the amplitude of that reward signal. I mean on paper it makes sense, but the but it doesn't always play a part of it And practice it doesn't play out. That's right. And so I'm gonna refer you now to an old literature that was from 2006 there was a drug that was approved in Europe called Ramana band Okay, a trade name accomplia And it was approved in Europe for weight loss and it was pretty good at weight loss. So it caused about 20 % weight loss It also caused severe depression and 21 suicides So it's no longer available because it was the end yeah, it was pulled from the European market never approved in the United States And the reason this happened was because this was the anti marijuana drug This was the anti -munchies drug.

2:50:12This was an endocannabinoid antagonist Well, when you reduce reward You also reduce your desire to live And that's why this concern about reduction in alcohol consumption We've already seen major depressive disorder in patients receiving ozampic So are we gonna see the same thing play out as we did for Ramana band? I'm worried about it or fenn fenn Well, fenn fenn didn't have No, it was cardiac it was cardiac right we had cardiac problems Due to the fenn flurming Because of the serotonin 1b receptor agonism right I'm just referring to the fact that these these quote -unquote blockbuster drugs for obesity They tend to follow a contour of you know, very promising very exciting a lot of people losing weight Suicides are very promising a lot of people losing weight Um cardiac issues very promising losing weight and now you're saying the stomach turns to stone sound sound so biblical Well indeed So that's the question and then finally we can really talk biblical If everyone in America who qualified for ozampic got it That would be 2 .1 trillion to the health care system Which is currently at 4 .1 trillion So that'd be a greater than 50 % increase in health care costs Okay at 1300 a month Conversely If we just got sugar consumption down to USDA guidelines By basically, you know putting some limits on how much added sugar the food industry can put into any given product like fruit loops We could reduce weight by 29 % And save 3 .0 trillion dollars So we'd get better weight loss And we'd save 5 .1 trillion dollars Which makes more sense to the US government Well earlier you were alluding to government uh Big food big pharma Relationships.

2:52:19I mean there's a huge win here for whoever's manufacturing these Chlp1 analogs indie um but the question is who's paying the tab well we are Um now the question is why can't the government see that and the answer is because the government's on the dull too Because the government Uh Through tariffs on US made foods Okay grosses 56 billion dollars a year So they're a player they're not just a regulator They're an actor to play devil devil's advocate a little bit Listen i'm gonna be the last person to step in and try and defend Government as a unified body i'm not qualified to do that But you could see how it if you looked at it like checkers instead of chess You'd say okay here's a drug that's going to allow Many millions of people To reduce their overall body weight overall body weight is a risk factor for a number of things um and There will be savings on the back end as a consequence of that weight loss I mean so that's the checkers version right the chess version is how you're describing it and i think that um i mean Clearly people in government are are Well most some Perhaps are smart enough to play chess not checkers or to at least understand it But there's very little incentive for the chess model so um what would Quote and quote solve this problem is the same thing that happened offend fenn or this Romana romantic room which is if suddenly there's a major issue with the drug Then everyone stops taking it and traditionally that's how it's gone It sounds like these chlp1 analogs are gonna make it through the shoot though.

2:53:58Yeah, I mean There is a very clear downside to these medicines on the other hand You know there's an upside and so i'm not Sad that these medicines exist. I'm for them. I'm not against them I'm for them for the right patient and right now It's not the right patient who's getting them just like the stadans So what if somebody who's taking one of these analogs makes it a point to do resistance training And here you know you mentioned bodybuilders early I'm not I'm not suggesting they become bodybuilders But we now know and I think Peter or Tia and others would agree that Everybody should be doing some form of muscle loss offsetting resistance exercise Agreed at least past you know they're reaching their adult height or something You know, I know there are those that say wait training doesn't blunt in your height But anyway, let's just say that from hit your early 20s onward Especially especially if you're on these medicines right in order to maintain muscle mass So that's a different picture right people are drinking less alcohol again.

2:55:01I'm playing devil's advocate here So if we look at these these compounds not in a vacuum But okay the person who's been carrying that extra 30 pounds is now only carrying a few extra Pounds of adipose tissue they've lost a lot of muscle But now they feel well enough to exercise The depression part worries me. Yeah, but anyway, I'm just I'm just trying to round the contour of it What we've seen in children, you know because that's who I took care was that often they needed a jumpstart Okay, and there were different ways to get them to jumpstart stomach stapling. Well, that's not jumpstart That was what a lot of people did I know I know I have a friend he's he was and sadly still is really big And he always talked about the stomach stapling like if I could just get 50 pounds down quickly Then I could exercise but exercise is painful this kind of thing and sadly he's he's continued to maintain or creep up in a very excessive weight And that's the point is you know that this concept of jumpstart Actually, if you're only doing it yourself doesn't really work and the question is Why is his weight creeping up if he's had the stomach stapling the answer is because he's a sugar addict Yeah, he's definitely addicted to the super big gulp soda If you drink your calories It doesn't really matter does it No, and he's got such terrible psoriasis and joint pain and all this that the prospect of exercising is like a You might as well tell him to to like flap his wings and go to Mars You know fructose is a driver of immune dysfunction if he got off you can tell him from me If he got off the sugar his psoriasis would get better his weight would get better his arthritis would get better And he could have then that jumpstart This is a perfect example to bridge to the brain component of all this because I've long wondered based on what I understand about neural circuitry and neuroplasticity I know we share in this knowledge that at some point carrying a lot of adipose tissue Means that the brains who have represents the body differently I mean, we know they're these these somatotopic maps of self You know, but that the neural machinery and the hypothalamus sure which is responsible for motivated states etc but but also just the entire mapping of the self changes in other words if one is fat long enough that it becomes Increasingly hard to get to a healthy weight Because of the way that the neural circuitry is impacted it basically remaps to maintain that that fat person Not necessarily even just at the level of appetite But just in terms of what do you what do big animals do I had a bulldog the weight 90 pounds bulldog massive He was very economical with his movement Right, he's extremely powerful he could run at least in when he was younger And but if he could be still he was still as opposed to certain smaller animals that are like peripatetic right because because he was leptin resistant So leptin as we talked about briefly is The hormone that tells your brain you've had enough if you are leptin sensitive You are happy to burn if you are leptin resistant your brain thinks you're starving And if your brain thinks you're starving it's going to affect your behavior in two ways It's going to make you want to eat and so I'm just going to make you want to conserve Because the goal is to try to increase the leptin levels in order to overcome that resistance Which of course you can never do because all you're going to do is lay down more fat and make more leptin That makes so much sense because leptin comes from the adipose tissue exactly So That leptin resistance is what you have to Be able to break through you have to fix the leptin sensitivity well.

2:58:48What's the driver of the leptin resistance? insulin insulin inhibits leptin signaling And it does it at three separate places in the palm -seen neuron the pro opiolamalena Quartan neuron in the hypothalamus it does it at IRS to insulin receptor substrate to it does it it sucks three suppressor cytokine signaling three and it does it at PIP -3 phosphatidal and osteopor triphosphate those three separate arms of the leptin receptor are all Basically put to sleep by high insulin insulin blocks leptin signaling So the higher the insulin goes the more your brain thinks you're starving and the more your brain thinks you're starving The hunger you get and the less you want to move so the gluttony and sloth that we've been talking about all all in a podcast Is really biochemical it is secondary to this phenomenon of insulin blocking leptin signaling You got to fix that first get the insulin down any way you can and the best way Get rid of the refined carbohydrate and sugar That's where you start It makes so much sense It works too.

3:00:11How about that? That's always good. It is I once heard you say I think it was in a conversation with Peter Tio and his podcast and this really stuck in my mind that when A person consumes glucose That it activates a number of different brain sites, you know neurons loving glucose But that when one ingest fructose That it preferentially activates neurons in the reward pathway that's right at maybe seven times the The magnitude or or something like that glucose activates the basal ganglia Uh, this is work from Wollnerhausen and Switzerland and also Eric Stys at our health side movement and planning and execution exactly Okay, fructose Basically stimulates the nucleus accumbens the reward center It is just like heroin just like cocaine just like nicotine it activates the reward center it doesn't do anything for the basal ganglia so it is addictive Anything that stimulates the reward center in the extreme is addictive So we have chemical addictions heroin cocaine nicotine alcohol sugar.

3:01:24We have behavioral addictions shopping gambling internet gaming social media pornography done matter they all stimulate dopamine in the reward center and in the extreme they are all addictive so the question is if you are addicted Is That personal responsibility well, it's uh a very um It's a question I think about a lot because uh, I know a lot of people in the addiction recovery community Both from the treatment end in the Addicton yeah, and there's always comes down to this question when somebody is suffering from an addiction of any kind and they're resistant to getting treatment If you look at it them as as being sick at least in that moment Is a sick person in the best or worst or at least diminished position to guide their own treatment so for instance somebody with dementia would you ask them do you want to go see a neurologist You might ask them that but are they the best person to make that decision?

3:02:28Well, this is the problem. So this is this is where personal responsibility falls down So personal responsibility as we you know, we talked about four criteria have to be met none of them are met That's the first issue Second one is a little bit shall we say cheek gear Who invented personal responsibility? Any idea? I'm definitely gonna get this one wrong. Yeah, you're gonna get this one wrong. Are you ready? Yeah, I don't know the tobacco industry The notion of personal responsibility. They invented it There was no personal responsibility until tobacco in 1962 because they were getting killed on the science And they needed to invent another reason for you to smoke In fact, there's a paper that came out dorfman at all that looked at the New York Times and the Washington Post and they did a entire lit search of the entire of You know the all the output of those two newspapers For decades to look for the term personal responsibility and the very first time it was ever mentioned was 1962 and it didn't pick up in speed until 1986 which was the same year as sipelony v.

3:03:45ligate In the sethosupreme court which basically said that the you know that cigarette industry was was guilty of of Playing people with an addictive substance So this is very specifically industry driven and we have the data to prove it amazing well I wonder Along the lines of personal responsibility Given that many listeners This conversation are going to be thinking about their own food intake and food choices That of their children and other relatives Then how we could play a little a little uh, not a game but a little Rapid -ish fire Q &A Never done this before in this podcast But I think it's particularly appropriate for a discussion like this that Wicks out into so many areas and I absolutely will invite you back and I'm perhaps along with This apple to talk about some of the exciting work you guys are doing because there's so much we could cover But people are going to wonder in a very practical sense Whether or not they should or should not be consuming certain things and I know you're not the food police I'm not the food police and I'm not a cop and I do believe people should or should be in choice About these matters But I also believe that Because you're guest on the podcast and you're highly informed and and and I've done with clinical work and research for so many years in this area And you have such a clear stance on the role of big food and and we really Really appreciate your honesty and directness But not you'd be willing to provide a comment about a couple of different terms that all throw out And if you choose to say really nothing to say about that fine that would be a quick pass So um here we go um and we covered a little bit of this earlier, but fruit in whole form so um Has fructose but has fiber so uh thumbs up thumbs sideways or thumbs down for fruit consumption fruit is fine fruit juice is not Great.

3:05:46Thank you white rice versus brown rice and among the white rice is the sticky rice um and the rice is with added sugars Which you find in in a lot of um in a lot of restaurants brown rice because of the fiber white rice polished You know number one all the vitamin B one gone and of course a march large or glucose excursion that glycemic index thing Which of course I hate is it's glycemic load that matters and That is a very high glycemic load. So brown rice. So brown rice is better than white rice. Yes. Okay. In a meaningful way in a meaningful way Okay Earlier you mentioned tomato sauce. I love tomato sauce that's made from just tomatoes Can to make so is our most tomato sauce is filled with sugar?

3:06:36perfect our little recommendation engine looked at this question and it turns out that only 10 % of the available Tomato sauces out on the market Don't have added sugar So you have to know which ones where you can look yourself or you can look up perfect and it will tell you which ones you can buy If people chose to consume bread which many people do Is there a way to Just across the board without just baking your own or see or looking at the ingredients list to make a better choice is it like sour Does tend to have less sugar than blank Well sourdough has been fermented so it will have actually consumed some of the sugar So it would be a better choice But really the best choice is the highest fiber breads now If you look at a wheatberry It is 25 % fiber the husk is 25 % of the weight of that wheatberry That means that the carbohydrate to fiber ratio of a wheatberry is three to one So a good bread should have a carbohydrate to fiber ratio of somewhere between three to one to five to one tops Anything above that means that they've stripped the fiber away So that's something you could do but the easier way is to actually look it up on perfect You mentioned meat and meat sourcing Egg and chicken sourcing earlier.

3:08:05Maybe we'd just revisit that Meat -fishing eggs Thumbs up thumb sideways thumbs down or it depends it depends depends on Where the meat came from it depends on whether it was pasture raised depends on whether it's organic or not if they Animal was injected with antibiotics stay away from it because those antibiotics are in the meat They're gonna basically sterilize your gut and then the bad bacteria are gonna take over We haven't really talked much about the microbiome today But that's a whole podcast all by itself Well, we can touch on it a little bit more from low sugar fermented foods thumbs up thumbs sideways thumb down Short -chain fatty acids All good.

3:08:48What are your favorite sources of fermented foods? I like kimchi. Yeah I like kimchi to I like some of the live sour crouts. Yeah, that's also good But with the right you know the right accoutrement The one thing I would be Careful about is yogurt Okay, so there are yogurts with live cultures and there are a whole lot of yogurts with dead cultures And if it's a yogurt with dead cultures, it's kind of irrelevant and the chances are they've actually covered up the sourness with sugar so Come or you know large commercially available yogurt be very very careful Okay, if it's a you know artisan yogurt, you know made by a you know people you know or trust You know that's a very different story you know Yogurts with live cultures Intermittent fasting do you practice it and what do you think about it?

3:09:42I don't practice it, but I am for it For the right patient turns out who's the right patient the patient with liver fat Because the reason it works is because it gives the liver a chance to Basically burn off the fat that it's stored zero calorie soda Got it. It's definite no and I don't even have to ask about sugary soda because that's that's that's basically just poison and it can Food combinations I have a feeling I know what your answer is but the glycemic index which we know your feelings on now Asserts that if you combine some fat with a sugary like like eating ice cream you have a more blunted insulin response Then if you were to eat pure sugar of equivalent calories, but What are your thoughts on food combinations as a way to blunt the insulin response?

3:10:32Food combinations are great if there's some fiber associated with it Comes back to fiber again and by the way and by the way I you know full disclosure. I am the chief medical officer of a fiber company What is it? It is called biolumine And it is a proprietary fiber. It is a microcellulose sponge Seven microns in diameter. So the size of a red blood cell You swallow it It goes to your stomach it expands 70 fold over its original size and so it'll give you a feeling of fullness because it's taking up space in the stomach but more importantly When it expands the nooks and the crannies in the sponge become Available and embedded in those nooks and crannies are a set of proprietary hydrogels Syable fiber which sequester glucose fructose sucrose simple starches and render them unavailable for early absorption in the Duodenum thus reducing the glucose response reducing the insulin response protecting the liver and moving it through the intestine so that microbiome can shoot up for its own purposes feeding the gut We can reduce glucose absorption by 36 percent fructose absorption by 38 percent sucrose absorption by 40 percent simple starch absorption by 9 percent and increase short -chain fatty acid production by 60 percent without an increase in gas When do people take this with meals?

3:12:07Okay, so it comes as a sachet One teaspoon sprinkle it on your food or take it as a you know in a drink You know just mix it in and slug it down and then eat breakfast lunch or dinner and it will basically act like you ate real food It will turn processed food into real food in the intestine and we have Clinical trial data that demonstrates that is it available as a commercial is available it is called Munch munch now I hate that name I didn't make it up Well You get a market you're marketing team sucks, but the product sounds amazing biolum and dot tech great thank you for that Sorry munch munch marketing team, but you got a munch munch to a new product name um But it sounds like a very interesting product and it actually answered my next question which was about fiber supplements fiber is good, but there are two kinds of fiber There's soluble and there's insoluble and they are not the same So soluble is what goes into fiber one bars, you know that's psyllium Inulin Pectin well like we're holds jelly together Um, that's good.

3:13:27I'm not saying it's bad, but you need the insoluble fiber the cellulose The stringy stuff in celery the cardboard if you will Um, together they formed this gel that we talked about earlier If you only consume the soluble fiber, which is what the food industry will add to food because the insoluble fiber is not missable If you only add the soluble fiber back, you're not getting the benefits of the entire fiber complement Earlier when talking about the Nova system and how Most all of our foods are nine let's say I know is seven to ten percent Let's say 95 percent let's err on the side of better 95 percent of our foods should come from Nova system class one or class two foods or three or three Okay, staying away from those Nova class four foods.

3:14:14Could you give us some examples of Nova class one and class two foods um, it just Broadly speaking okay Nova class one is any food without a label Period If you see a label on a food, it's a warning label Well, there's ground ground beef has a label Okay, so that's well does it so you're talking about apple Well, when I buy it it has a label. I'm asking us because people are gonna wonder so well doesn't have a nutrition facts label Is there a nutrition facts label on a thing of ground beef? I buy that's that uh ground beef where I consume venison Where if you flip it over it says how many calories how many protein it so there's a label um But but it's just beef or venison okay, okay, and that's class one okay egg Egg is class one So and then of course fruit apples orange okay, so it doesn't matter if it has it has a name a name tag as long as it It doesn't have any Real food does not need a label.

3:15:14It's only if they did something to it that it needs a label So you have to look at every label as a warning label now the problem with the label is it only tells you what's in the food What you really need to know is what's been done to the food Because it's the ultra -process food. That's the problem. They don't want to tell you that that's secret Okay, secret from a proprietary standpoint, but also secret because if you knew what they did to it You wouldn't need it you would never buy it and they don't want you to know so they only tell you what's in the food That's not what's important. It's what's been done to the food that's important And that's why this noble class for is so important and that's why perfect is so important because it'll do the work for you Great.

3:15:56We'll definitely provide links to all of these so If you could pick one thing to recommend to people That want to improve their health get rid of sugar. Okay, very clear. That's number one at number two Go for a walk the exercise piece. Yeah, go for a walk and if you could recommend one thing that The general public can do to try and um Assist in this advocacy for Not redefining but actually clearly defining what is food and what isn't and making people aware um at the level of policy and change and school lunches I mean if there were one thing what can we do? I mean I you've clearly activated minor on surrounding like the the set of problems that exist and the the paths to correct them But should we be writing to our congresspeople should we be um getting angry at hospitals because they've got all these fast food machines and That the cafeteria food is like is like is like illness promoting At UCSF we've gotten rid of all sugar beverages.

3:17:02We have the healthy beverage initiative So no machines at UCSF. Wow Stanford check that out because you know people always send me pictures of the of the coke machines in the school of medicine I'm like listen. I didn't put them there, but I I I we have to model for the public, you know, I mean where where was the first place that smoking was banned hospitals Okay, because we knew so if you get rid of the you know Uh Soda if you get rid of the sugar soda at the hospital you're telling people something So yeah, I think that every hospital and really every public venue in America needs to clear out the junk So post photos of junk that are supposed to be in in health promoting institutions and um, I guess the we're trying to cancel junk We're trying to shave I'm pretty opposed to cancel culture, but here we go.

3:17:57I'm gonna cancel um Marvelous. It's actionable. It's straightforward. It's low cost low time investment zero cost Very low time investment. Thank you for that and look up eat real Because we're doing it for your kids So you need to help support it any school district in America can do it So what do we do? We have a business model whereby the uh food services director Um, either purchases or rents a dilapidated factory in the center of the district Repurposes it into a food preparation facility. They can make 27 to 30 ,000 meals a day Okay, with a you know skeleton crew And then they and and you control what's in it and because you're buying in volume It actually reduces the cost so it's cheaper than buying it from Cisco or arrow mark or sedex or wherever and then you farm it out via you know, truck or bus to all the different schools So every kid gets a hot meal made from scratch each day and we can solve this problem Can't help but ask this one last question for people that want to cut out sugar Would you clearly state it is the most important thing to do for one's health How do we know how much sugar is in something i so should people be looking at labels and just looking for how much sugar how much carbohydrate or Could we even go so far as to say if it says um high fructose corn syrup then it's it's on the no fly list Don't don't don't need it so the problem the problem is that there are 262 names for sugar And the food entry uses all of them And the reason they use all of them is because they can Include a different sugar as number five number six number seven number eight number nine on the list When you add it up it could it becomes number one They hide it in plain sight and they do it on purpose now Do I expect everybody to memorize all 262 names?

3:20:05No, of course not Can you figure it out yourself? Well the answers no unless they have the line Where it says added sugars if it says added sugars it is either sucrose or high fructose corn syrup no one's adding lactose Okay, that's not more glucose They're not even adding glucose because glucose isn't that sweet glucose is not that interesting You don't see people going around chugging carose syrup do you okay? That's glucose who cares? Yeah might be good in the molasses cookie But that's it all right So it's fructose So you need to know what's been added so if it says added sugars that's a good place to start No greater than one teaspoon per serving no greater than four grams Per serving of added sugars anything greater than that leave it the store And aim for those Nova type type one type for Nova aim for Nova types one two and three And if you don't know whether it's Nova type one two or three you can use perfect And if you don't look at that then go look at the nutrition facts label and anything that has more than four ingredients Is Nova class four Robert Lustig Thank you so much.

3:21:23You've provided such an incredible Education in nutritional biochemistry the processing of fat protein carbohydrate sugar fructose in particular The clear detriment of consuming fructose on so many different organ systems I love love love that you separated out food science nutrition and metabolic Health or self that's just I that's a you know, that's a gazillion dollar Delineation for people to understand and to shape their understanding of all the information that's out there Is to and bins into these different categories You've given us so many actionable tools New conceptual frameworks you've given us a real tour de force today in A just oh so clear language.

3:22:10So I want to thank you I learned a ton and And I know everyone else has as well and if people have questions they can Of course put them in the comment section on youtube. That's the best place. We'll provide links to all the the companies and websites that that you referenced and some of your other work and listen I just I'm so So grateful that you exist and that you've done the work that you've done and and your passion and your advocacy for health is It's just oh so clear. So thank you so much. So I want to I want to thank you And the reason I want to thank you is first of all you know inviting me that's nice.

3:22:48You know, that's good But the reason is because people need to understand science. I am completely Inagreement with you the public needs to understand science They listen to you Because you number one provide the science and number two you don't talk down You treat them as equals and that is Truly remarkable. And so I want to thank you for your serves well you're most welcome. It's a labor of love and um, I think it was the great max Delbrook that said uh When teaching assume zero knowledge and infinite intelligence and I do believe that humans are infinitely intelligent Although sometimes as a whole we mask it um People deserve the the knowledge.

3:23:33So thank you so much for sharing that knowledge today And let's absolutely have you back my pleasure. Thank you Thank you for joining me for today's discussion with dr. Robert Lustig about nutrition and how sugar impacts the health of our brain and body To learn more about dr. Lustig's work and to find links to the many books that he's written on this and other topics Please see the show note captions if you're learning from and or enjoying this podcast Please subscribe to our youtube channel. That's a terrific zero -cost way to support us in addition Please subscribe to the podcast on both Spotify and Apple and on both Spotify and Apple You can leave us up to a five star review If you have questions for me or comments about the podcast or guess you'd like me to consider on the hubramin lab podcast Please put those in the comment section on youtube.

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3:25:55Robert Lustig and last but certainly not least Thank you for your interest in science